Functional Outcomes After Isolated and Combined Posterior Cruciate Ligament Reconstruction in a Military Population

Christopher J Tucker; Eric J Cotter; Brian R Waterman; Kelly G Kilcoyne; Kenneth L Cameron; Brett D Owens

doi:10.1177/2325967119875139

Functional Outcomes After Isolated and Combined Posterior Cruciate Ligament Reconstruction in a Military Population

Orthop J Sports Med. 2019 Oct 11;7(10):2325967119875139. doi: 10.1177/2325967119875139. eCollection 2019 Oct.

Authors

Christopher J Tucker¹, Eric J Cotter², Brian R Waterman³, Kelly G Kilcoyne⁴, Kenneth L Cameron⁵, Brett D Owens⁶

Affiliations

¹ Department of Orthopedic Surgery and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA.
² Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin, USA.
³ Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
⁴ Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA.
⁵ Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, New York, USA.
⁶ Department of Orthopaedic Surgery, Brown University Alpert School of Medicine, Providence, Rhode Island, USA.

Abstract

Background: The rates of return to full activity, persistent disability, complications, and surgical revisions after operative management of posterior cruciate ligament (PCL) tears in a physically active population have not been reported.

Purpose: To evaluate the clinical outcomes of active military patients with symptomatic PCL tears who underwent surgical reconstruction and compare outcomes between isolated PCL and multiligament injuries.

Study design: Cohort study; Level of evidence, 3.

Methods: Individuals undergoing surgical reconstruction of the PCL (Current Procedural Terminology code 29889) were isolated from the Military Health System Management Analysis and Reporting Tool between fiscal years 2005 and 2010. Demographic variables and rates of postoperative complications, activity limitations, rates of revision surgery, physical disability ratings, and ultimate medical discharge were recorded from the electronic medical record and US Army Physical Disability Agency database.

Results: A total of 182 patients underwent 193 surgeries, including 118 isolated PCL reconstructions and 75 multiligament knee reconstructions, with an average follow-up of 19.5 months. There were 174 primary procedures and 19 revision reconstructions. The mean ± SD patient age was 28.4 ± 7.2 years, with males comprising 96.2% of patients. The overall surgical complication rate was 12.4%, with a significantly higher rate in multiligament knee reconstructions compared with isolated PCL reconstructions (18.7% vs 8.5%; P = .045). Overall, 35.1% of patients were discharged from military service due to disability. Rates of discharge were significantly higher in those undergoing surgery at lower volume institutions (those that performed <2 PCL reconstructions per year during the study period) than those at higher volume institutions (41.1% vs 26%; P = .040). The overall revision rate was 10.9%, with no significant difference between the isolated PCL and multiligament knee reconstructions. Of the 103 patients with primary isolated PCL reconstructions, 35% underwent medical discharge for persistent knee complaints, and 12.6% required revision PCL reconstruction. The overall failure rate for primary isolated PCL reconstructions, which includes both revision surgery and knee-related medical discharge from military service, was 42.7%.

Conclusion: In a physically active, military population, nearly one-third of patients were unable to return to previous level of military function, and 12.6% required revision at short-term follow-up due to persistent instability. Perioperative complication rates were significantly higher among patients with multiligament knee reconstructions.

Keywords: disability; knee reconstruction; military; posterior cruciate ligament.