Reconstruction of the posterior cruciate ligament of the knee joint according to the technology «Onlay»

Authors

DOI:

https://doi.org/10.15674/0030-59872017373-84

Keywords:

knee joint, posterior cruciate ligament, arthroscopy, restoration, functional results, complications

Abstract

Posterior crossed ligament injury is one of the most serious damages to the capsular-ligament complex of the knee joint, which is difficult to detect.

Objective: to improve the treatment of patients with damage to the posterior crossed ligament of the knee by means of arthroscopic reconstruction using «Onlay» technology.

Methods: 56 patients (44 men, 12 women) with posterior crossed ligament injury were operated. In 32 (57.14 %) cases, isolated posterior crossed ligament raptures were detected, in 24 (42.86 %) — combined injuries. Patients are operated using RetroDrill® reverse drilling technology using arthroscopic iimplantation of quadriceps tendon.

Results: out of 56 patients in the period up to 6 years after the operation, it was possible to completely examine 21 individuals. Indicators on the VAS scale did not exceed 5 points in any case. In the assessment of mobility in the knee joint, 85 % of patients were assigned to a normal group, 15 % to almost normal. The joint function is recognized as normal in 5 % operated, almost normal — 15 %, moderate — 10 %, bad — 10 %. On the Kellgren-Lawrence scale, patients were divided into groups: 66.7 % — stage I with the onset of arthrosis, 28.57 % — stage II with slightly pronounced arthrosis, 4.76 % — stage III with moderate arthrosis.

Conclusions: arthroscopic «everything inside» with RetroDrill® can be recommended as an alternative to posterior crossed ligament reconstruction. Averaged time, subjective and objective results were optimistic. At the heart of this are subjective pleasure, objective stability, a return to sports, avoiding arthrosis changes. Due to insignificant number of observations in the absence of a control group, the interpretation of results is limited.

Author Biographies

Maksim Golovakha

Zaporizhzhia State Medical University. Ukraine

MD, Prof.

golovaha@ukr.net

Inna Didenko

Zaporizhzhia State Medical University. Ukraine

didenkoinna1991@gmal.com

Sergiy Krasnoperov

Zaporizhzhia State Medical University. Ukraine

MD, PhD

krasnoperovserg@gmail.com

Rostyslav Titarchuk

Clinic of modern surgery «Garvis», Dnipro. Ukraine

ros.titarchuk@rambler.ru

Кarl Benedetto

Schwerpunktkrankenhaus, Feldkirch. Austria

MD, Prof.

karl.benedetto3@lkhf.at

Weniamin Orljanski

Vienna Private Clinic. Austria

MD, Prof.

orljanski@hotmail.com

References

  1. Dubrov VE. Surgical correction of the cruciate and collateral ligaments of the knee joint during the acute phase of injury: сlinical and experimental research. Dissertation doctor of medical sciences. Moscow, 2003. 48 p. (in Russian).
  2. Kotelnikov GP, Kuropatkin GV, Brewers MV. Biomechanics posttraumatic instability of the knee. Biomechanical studies in traumatology and orthopedics. Moskow, 1988, рр. 6-13. (in Russian)
  3. Linko YV. Diagnosis and treatment of posterior instability of the knee. Оrthopаedics, Traumatology and Prosthetics. 2001;(1):106-9. (in Russian).
  4. Lіnko YV. Posttraumatic rear nestabіlnіst kolіnnogo Suglob (klіnіko-experiental doslіdzhennya): аbstract dis. the candidate of medical science. Kyiv, 2004. 16 p. (in Ukrainian).
  5. Orletsky AK. Operative treatment of posttraumatic chronic instability of the knee joint: аbstract dis. the doctor of medical science. Moskow, 1998. 38 p. (in Russian).
  6. Clinical and radiological long-term outcome after posterior cruciate ligament reconstruction and nonatomical popliteus bypass / T. Adler, N. F. Friederich, F. Amsler [et al.] // Int. Orthop. — 2015. — Vol. 39 (1). — P. 131–136. — DOI: 10.1007/ s00264-014-2515-7.
  7. Benedetto KP, Hoffeiner T, Osti M. The biomechanical characteristics of arthroscopic tibial inlay techniques for posterior cruciate ligament reconstruction: in vitro comparison of tibial graft tunnel placement. Int. Orthop. 2014;38(11):2363–2368. DOI: 10.1007/s00264-014-2458-z.
  8. Benedetto KP. Arthroskopischer Ersatz des hinteren Kreuzbandes. Jatros Unfallchirurgie & Sporttraumatologie. 2012;1:6–8.
  9. Benedetto KP. Tibial-inlay-Technik beim hinteren Kreuzbandersatz. Arthroskopie. 2006;19(3):258–264. DOI: 10.1007/s00142-006-0361-3.
  10. Bergfeld JA, Graham SM, Parker RD, Valdevit AD, Kambic HE. A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques. Am. J Sports Med. 2005;33(7):976–981. DOI: 10.1177/0363546504273046.
  11. Bergfeld JA, McAllister DR, Parker RD, Valdevit AD, Kambic HE. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am. J Sports Med. 2001;29(2). DOI: 10.1177/03635465010290020401.
  12. Boynton MD, Tietjens BR. Long-term follow up of the untreated isolated posterior cruciate ligament-deficient knee. Am. J Sports Med. 1996;24(3):306–310. DOI: 10.1177/036354659602400310.
  13. Campbell RB, Jordan SS, Sekiya JK. Arthroscopic tibial inlay for posterior cruciate ligament reconstruction. Arthroscopy. 2007;23(12):1356.e1–1356.e4. DOI: 10.1016/j.arthro.2007.01.020.
  14. Campbell RB, Torrie A, Hecker A, Sekiya JK. Comparison of tibial graft fixation between simulated arthroscopic and open inlay techniques for posterior cruciate ligament reconstruction. Am. J Sports Med. 2007;35(10):1731–1738. DOI: 10.1177/0363546507302216.
  15. Christel P. Basic principles for surgical reconstruction ofthe PCL in chronic posterior knee instability. Knee Surg. Sports Traumatol. Arthrose. 2003;11(5):289–296. DOI: 10.1007/s00167-003-0407-2.
  16. Chuang TY, Chen CH, Chou SW, Chen YJ, Chen WJ. Tibial inlay technique with quardriceps tendon-bone autograft for posterior cruciate ligament. Arthroscopy. 2004;20(3):331–335. DOI: 10.1016/j.arthro.2003.11.043.
  17. Cury Rde P, Mestriner MB, Kaleka CC, Severino NR, de Oliveira VM2, Camargo OP. Double-bundle PCL reconstruction using autogenous quadriceps tendon and semitendinous graft: surgical technique with 2-year follow-up clinical results. Knee. 2014;21(3):763– 768. DOI: 10.1016/j.knee.2014.02.021.
  18. Fanelli GC, Sousa PL, Edson CJ. Long-term followup of surgically treated kneedislocations: stability restored, but arthritis is common. Clin. Orthop. Relat. Res. 2014;472(9):2712–2717. DOI: 10.1007/ s11999-014-3707-6.
  19. Kim YM, Lee CA, Matava MJ. Clinical results of arthroscopic singlebundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am. J Sports Med. 2011;39(2):425–434. DOI: 10.1177/0363546510374452.
  20. MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF. Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year foilow-up. Arthroscopy. 2006;22(2):320–328. DOI: 10.1016/j.arthro.2005.08.057.
  21. Margheritini F, Frascari Diotallevi F, Mariani PP. Posterior cruciate ligament reconstruction using an arthroscopic femoral inlay technique. Knee Surg. Sports Traumatol. Arthrose. 2011;19(12):2033–2035. DOI: 10.1007/s00167-011-1469-1.
  22. Mariani PP, Margheritini F. Full arthroscopic inlay reconstruction of posterior cruciate ligament. Knee Surg. Sports Traumatol. Arthrose. 2006;14(11):1038–1044. DOI: 10.1007/s00167-006-0086-x.
  23. Markolf KL, Zemanovic JR, McAllister DR. Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. J Bone Joint Surg. Am. 2002;84-A(4):518–524.
  24. Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy. 2000;16(8):796–804.
  25. McAllister DR. Hussain SM. Tibial inlay posterior cruciate ligament reconstruction: surgicai techniques and results. Sports Med. Arthrose. 2010;18(4):249–253. DOI: 10.1097/JSA.0b013e3181faaee1.
  26. Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: indications, techniques, and outcomes. Curr. Rev. Musculoskelet. Med. 2013;472(9):115–123. DOI: 10.1007/ s12178-013-9162-2.
  27. Patel DV, Allen AA, Warren RF, Wickiewicz TL, Simonian PT. The nonoperative treatment of acute, isoiated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate term follow-up study. HSS J. 2007;3(2):137–146. DOI: 10.1007/s11420-007-9058-z.
  28. Petersen W, Zantop T, Tillmann B. Anatomie des hinteren Kreuzbandessowie der posterolateralen und posteromedialen Strukturen. Arthroskopie. 2006;19(3):198–206. DOI: 10.1007/s00142-006-0357-z.
  29. Petersen W, Zantop T. Biomechanik des hinteren Kreuzbandes und derhinteren Instability. Arthroskopie. 2006;19(3):207–214. DOI: 10.1007/ s00142-006-0358-y.
  30. Russe K, Schulz MS, Strobel MJ. Epidemiologie der hinteren Kreuzbandverletzung. Arthroskopie. 2006;19(3):215–220. DOI: 10.1007/s00142- 006-0354-2.
  31. Salata MJ, Sekiya JK. Arthroscopic posterior cruciate ligament tibial inlay reconstruction: a surgical technique that may influence rehabilitation. Sports Health. 2011;3(1):52–58. DOI: 10.1177/1941738110385308.
  32. Schewe B, Fritz J. Die Rekonstruktion des hinteren Kreuzbandes [web source]. Operations technik. SFA Arthroskopie Aktuell. 2007. Available from: https: //www.dgou.de/fileadmin/user_upload/Dokumente/Publikationen/SFA/SFA_Aktuell_Nr20.pdf.
  33. Schulz MS, Richter J. Diagnostik der hinteren Kreuzbandlasion. Arthroskopie. 2006;19(3):221–228. DOI: 10.1007/s00142-006-0355-1.
  34. Seon JK, Song EK. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlaytechniques. Arthroscopy. 2006;22(1):27–32. DOI: 10.1016/ j.arthro.2005.08.038.
  35. Shelbourne KD, Muthukaruppan Y. Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy. 2005;21(4):457–461. DOI: 10.1016/j.arthro.2004.11.013.
  36. Song EK, Park HW, Ahn YS, Seon JK. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow up study. Am. J Sports Med. 2014;42(12):2964–2971. DOI: 10.1177/0363546514550982.
  37. Strobel MJ, Weiler A. Therapie der chronischen HKB-Lasion Arthroskopie. 2006;19(3):243–257. DOI: 10.1007/s00142-006-0360-4.
  38. Weiler A, Schmeling A, Jung TM. Management der akuten HKB Verletzung. Arthroskopie. 2006;19(3):229–242. DOI: 10.1007/ s00142-006-0356-0.
  39. Weimann A, Schatka I, Herbort M, Achtnich A, Zantop T, Raschke M, Petersen W. Reconstruction of the posterior oblique ligament and the posterior cruciate ligament in knee with posteriomedial instability. Arthroscopy. 2012;28(9):1283–1289. DOI: 10.1016/j.arthro.2012.02.003.
  40. Zawodny SR, Miller MD. Complications of posterior cruciate ligament surgery. Sports Med Arthrosc. 2010;18(4):269–274. DOI: 10.1097/ JSA.0b013e3181f2f4c2.

Downloads

How to Cite

Golovakha, M., Didenko, I., Krasnoperov, S., Titarchuk, R., Benedetto К., & Orljanski, W. (2017). Reconstruction of the posterior cruciate ligament of the knee joint according to the technology «Onlay». ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 73–84. https://doi.org/10.15674/0030-59872017373-84

Issue

No. 3 (2017)

Section

ORIGINAL ARTICLES

License

Copyright (c) 2017 Maksim Golovakha, Inna Didenko, Sergiy Krasnoperov, Rostyslav Titarchuk, Кarl Benedetto, Weniamin Orljanski

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.

Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.

The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).