Time From Injury to Surgery Affects Graft Maturation Following Posterior Cruciate Ligament Reconstruction With Remnant Preservation: A Magnetic Resonance Imaging-Based Study

Abstract

Purpose: To evaluate the clinical outcomes and graft maturation following posterior cruciate ligament reconstruction (PCLR) with preserved remnant and further analyze the correlated factors affecting graft maturation.

Methods: Consecutive patients who underwent unilateral single-bundle PCLR with remnant preservation from January 2011 to October 2014 by the same senior doctor using tibialis anterior allografts and same surgical technique were included. At a follow-up of more than 2 years, range of motion (ROM) and posterior laxity assessed by posterior drawer test and the KT-1000 arthrometer were examined. Tegner, Lysholm, and International Knee Documentation Committee scores were evaluated. The graft maturation was assessed by a 3.0-T magnetic resonance imaging. Overall correlation analyses and multivariate regression analysis were performed to identify correlated factors of graft maturation, and then subgroups were divided and analyzed according to significant risk factor.

Results: Forty-three (84.3%) of 51 enrolled patients were successfully followed up (38.4 months, 24-54 months). All clinical scores improved significantly, and there were no complications. The results of KT-1000 difference revealed significant decline of posterior laxity (9.4 ± 1.5 vs 2.2 ± 1.5 mm; P < .001). The MRI evaluation confirmed no ligament retears. Both correlation and regression analyses showed time from injury to surgery had a positive, statistically significant weak correlation with the signal intensity score (R = 0.38, P = .012; coefficient = 0.10; P = .036). Subgroup (group 1: time from injury to surgery <3 months; group 2: 3-6 months; group 3: 6-12 months; group 4: ≥12 months) analysis showed there were no significant differences of clinical outcomes between subgroups, while MRI signal intensity was significantly lower in the group with shorter time from injury to surgery (P = .02).

Conclusions: The remnant-preserved PCLR resulted in satisfactory clinical outcomes and graft maturation at a mean follow-up of 38.4 months. The time from injury to surgery showed a weak positive correlation with postoperative graft signal intensity on MRI.

Level of evidence: Level III, retrospective comparative study.