The results of treatment of combined injuries of the posterior cruciate ligament and structures of the posterior lateral corner of the knee joint

Authors

  • Maksim Golovakha Zaporizhzhia State Medical University. Ukraine, Ukraine https://orcid.org/0000-0003-2835-9333
  • Inna Didenko Zaporizhzhia State Medical University. Ukraine, Ukraine
  • Sergiy Krasnoperov Zaporizhzhia State Medical University. Ukraine, Ukraine
  • Weniamin Orljanski Department of Orthopedic Surgery, Vienna Private Clinic. Austria, Austria

DOI:

https://doi.org/10.15674/0030-59872018492-101

Keywords:

knee joint, arthroscopy, posterolateral instability

Abstract

Insufficient attention to the structures of posterolateral knee corner in case of PCL injury can lead to unsatisfactory results. Objective: to improve the results of treatment patients with
posterior cruciate ligament injury by determining the indications for restoration of posterolateral knee corner structures. Methods: there were 68 patients without clear signs of rotation instability by Dial and Varus stress tests. But in all cases we observed asymmetry of these tests compare to contralateral leg. Patients were divided into two groups, homogeneous by gender and age: the main group (36 patients, 52.94 %) — restoration
of the PCL and the posterolateral structures, comparison group (32 patients, 47.06 %) — only PCL restoration. The results of treatment were evaluated with VAS and IKDS scales.
Results: а subjective assessment of patient’s satisfaction was obtained from 36 (100.00 %) patients in the main group and 30 from the comparison group (93.75 %). It was found out that 25 (37.88 %) patients were very satisfied with the early outcome of treatment (6 weeks), 34 (51.52 %) — satisfied, 5 (7.58 %) — partially satisfied, 2 (3.03 %) — not satisfied. Long-term followup results were assessed in 31 (86.11 %) patients of the main
group, 24 (75 %) — of comparison group. 30 (96.78 %) patients of the main group and 21 (91.3 %) of comparison group would agree to repeat surgery again. According to the subjective IKDC scale excellent and good results of treatment were found in 87.5 % of the main group, and only 47.37 % in the comparison group; unsatisfactory — at 4.15 and 15.79 % respectively. Conclusions: in all patients with PCL injury who had minor signs of rotational instability, restoration of the PCL and posterolateral structures allowed to get higher rate of excellent and good results after treatment. In patients with PCL injury and asymmetry
of external rotation test, it is necessary to reconstruct the PCL and structures of osterolateral corner. 

Author Biographies

Maksim Golovakha, Zaporizhzhia State Medical University. Ukraine

MD, Prof. in Traumatology and Orthopaedics

Sergiy Krasnoperov, Zaporizhzhia State Medical University. Ukraine

PhD in Traumatology and Orthopaedics

Weniamin Orljanski, Department of Orthopedic Surgery, Vienna Private Clinic. Austria

MD, Prof. in Traumatology and Orthopaedics

References

  1. Golovakha, M. L., Orljanski, W., & Benedetto, K. P. (2017). Posterior cruciate ligament ruptures. Zaporozhye: Prosvita. (in Russian)
  2. Dubrov, V. E. (2003). Surgical correction of cruciate and collateral ligaments of the knee joint in the acute period of trauma: Clinical and experimental research (Doctoral dissertation). Moscow. (in Russian)
  3. Bergfeld, J. A., McAllister, D. R., Parker, R. D., Valdevit, A. D., & Kambic, H. E. (2001). A biomechanical comparison of posterior cruciate ligament reconstruction techniques. American Journal of Sports Medicine, 29 (2), 129–136. doi: https://doi.org/10.1177/03635465010290020401
  4. LaPrade, R. F., Wentorf, F. A., Fritts, H., Gundry, C., & Hightower, C. D. (2007). A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 23 (12), 1341–1347. doi:https://doi.org/10.1016/j.arthro.2007.07.024
  5. Serra Cruz, R., Mitchell, J. J., Dean, C. S., Chahla, J., Moatshe, G., & LaPrade, R. F. (2016). Anatomic posterolateral corner reconstruction. Arthroscopy Techniques, 5 (3), e563–e572. doi:10.1016/j.eats.2016.02.006
  6. Frosch, K., Akoto, R., Drenck, T., Heitmann, M., Pahl, C., & Preiss, A. (2015). Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee. Operative Orthopädie und Traumatologie, 28 (3), 193–203. doi:https://doi.org/10.1007/s00064-015-0432-6
  7. Christel, P. (2003). Basic principles for surgical reconstruction of the PCL in chronic posterior knee instability. Knee Surgery, Sports Traumatology, Arthroscopy, 11 (5), 289–296. doi:https://doi.org/10.1007/s00167-003-0407-2
  8. Campbell, R. B., Torrie, A., Hecker, A., & Sekiya, J. K. (2007). Comparison of tibial graft fixation between simulated arthroscopic and open inlay techniques for posterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 35 (10), 1731–1738. doi:https://doi.org/10.1177/0363546507302216
  9. Cury, R. D., Mestriner, M. B., Kaleka, C. C., Severino, N. R., De Oliveira, V. M., & Camargo, O. P. (2014). Double-bundle PCL reconstruction using autogenous quadriceps tendon and semitendinous graft: Surgical technique with 2-year follow-up clinical results. The Knee, 21 (3), 763–768. doi:https://doi.org/10.1016/j.knee.2014.02.021
  10. Fanelli, G. C., & Larson, R. V. (2002). Practical management of posterolateral instability of the knee. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 18 (2), 1–8. doi:https://doi.org/10.1053/jars.2002.31779
  11. Geeslin, A. G., & LaPrade, R. F. (2010). Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. The American Journal of Sports Medicine, 38 (12), 2502–2508. doi:https://doi.org/10.1177/0363546510376232
  12. Hughston, J. C., & Jacobson, K. E. (1985). Chronic posterolateral rotatory instability of the knee. The Journal of Bone & Joint Surgery, 67 (3), 351–359. doi:https://doi.org/10.2106/00004623-198567030-00001
  13. Jordan, S. S., Campbell, R. B., & Sekiya, J. K. (2007). Posterior cruciate ligament reconstruction using a new arthroscopic tibial inlay double-bundle technique. Sports Med Arthrose, 15 (4), 176–183. doi: https://doi.org/10.1097/JSA.0b013e3181595b95
  14. Margheritini, F., Frascari Diotallevi, F., & Mariani, P. P. (2011). Posterior cruciate ligament reconstruction usäng an arthroscopic femoral inlay technique. Knee Surgery, Sports Traumatology, Arthroscopy, 19 (12),. 2033–2035. doi: https://doi.org/10.1007/s00167-011-1469-1
  15. Mariani, P. P., & Margheritini, F. (2006). Full arthroscopic inlay reconstruction of posterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 14 (11), 1038–1044. doi:https://doi.org/10.1007/s00167-006-0086-x
  16. Markolf, K. L., Zemanovic, J. R., & McAllister, D. R. (2002). Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. The Journal of Bone and Joint Surgery-American Volume, 84 (4), 518–524. doi:https://doi.org/10.2106/00004623-200204000-00002
  17. LaPrade, R F., Johansen, S., Agel, J., Risberg. M. A., Moksnes, H., & Engebretsen, L. (2010). Outcomes of an anatomic posterolateral knee reconstruction. The Journal of Bone and Joint Surgery. Am., 92 (1), 16–22. doi: https://doi.org/10.2106/JBJS.I.00474.
  18. Petersen, W., & Zantop, T. (2006). Biomechanik des hinteren Kreuzbandes und der hinteren Instabilität. Arthroskopie, 19 (3), 207–214. doi:https://doi.org/10.1007/s00142-006-0358-y
  19. Russe, K., Schulz, M. S., & Strobel, M. J. (2006). Epidemiologie der hinteren Kreuzbandverletzung. Arthroskopie, 19 (3), 215–220. doi:https://doi.org/10.1007/s00142-006-0354-2
  20. Salata, M. J., & Sekiya, J. K. (2010). Arthroscopic posterior cruciate ligament tibial inlay reconstruction. Sports Health: A Multidisciplinary Approach, 3 (1), 52–58. doi:https://doi.org/10.1177/1941738110385308
  21. Strobel, M. J., & Weiler, A. (2006). Therapie der chronischen HKB-Lasion. Arthroskopie, 19 (3), 243–257. doi:https://doi.org/10.1007/s00142-006-0360-4
  22. Montgomery, S. R., Johnson, J. S., McAllister, D. R., & Petrigliano, F. A. (2013). Surgical management of PCL injuries: indications, techniques, and outcomes. Current Reviews in Musculoskeletal Medicine, 6 (2), 115–123. doi:https://doi.org/10.1007/s12178-013-9162-2
  23. LaPrade, R. F., Muench, C., Wentorf, F., & Lewis, J. L. (2002). The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft. The American Journal of Sports Medicine, 30 (2), 233–238. doi:https://doi.org/10.1177/03635465020300021501
  24. Logan, M., Williams, A., Lavelle, J., Gedroyc, W., & Freeman, M. (2004). The effect of posterior cruciate ligament deficiency on knee kinematics. The American Journal of Sports Medicine, 32 (8), 1915–1922.
  25. LaPrade, R. F., Heikes, C., Bakker, A. J., & Jakobsen, R. B. (2008). The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. The Journal of Bone and Joint Surgery-American Volume, 90 (10), 2069–2076. doi:https://doi.org/10.2106/jbjs.g.00979
  26. Weiler, A., Schmeling, A., & Jung, T. M. (2006). Management der akuten HKB-Verletzung. Arthroskopie, 19 (3), 229–242. doi:https://doi.org/10.1007/s00142-006-0356-0

Downloads

How to Cite

Golovakha, M., Didenko, I., Krasnoperov, S., & Orljanski, W. (2023). The results of treatment of combined injuries of the posterior cruciate ligament and structures of the posterior lateral corner of the knee joint. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (4), 92–101. https://doi.org/10.15674/0030-59872018492-101

Issue

No. 4 (2018)

Section

ORIGINAL ARTICLES

License

Copyright (c) 2019 Maksim Golovakha, Inna Didenko, Sergiy Krasnoperov, 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).