Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Yi-Jou Chen; Cheng-Pang Yang; Chin-Shan Ho; Chun-Jui Weng; Alvin Chao-Yu Chen; Wei-Hsiu Hsu; Kuo-Yao Hsu; Yi-Sheng Chan

doi:10.1177/23259671221115423

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Orthop J Sports Med. 2022 Aug 12;10(8):23259671221115423. doi: 10.1177/23259671221115423. eCollection 2022 Aug.

Authors

Yi-Jou Chen^{1

2}, Cheng-Pang Yang^{1

2

3}, Chin-Shan Ho⁴, Chun-Jui Weng^{1

2

3}, Alvin Chao-Yu Chen^{1

2

3}, Wei-Hsiu Hsu⁵, Kuo-Yao Hsu^{1

2

3}, Yi-Sheng Chan^{1

2

3

6}

Affiliations

¹ Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.
² Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.
³ Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.
⁴ Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan.
⁵ Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi.
⁶ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung.

Abstract

Background: There is a lack of consensus regarding the optimal technique for revision posterior cruciate ligament (PCL) reconstruction.

Purpose: To evaluate midterm outcomes after revision PCL reconstruction using a single-bundle transtibial autograft.

Study design: Case series; Level of evidence, 4.

Methods: We reviewed 17 patients who underwent revision PCL reconstruction performed in our medical center by a single surgeon from 2003 to 2016. The cohort included 12 male and 5 female patients with a mean age of 31.3 years (range, 17-48 years). All of the patients underwent single-bundle transtibial reconstruction using the same surgical technique and were reviewed at a minimum of 4 years postoperatively. Preoperative and postoperative posterior stress radiography was performed. The preoperative tibial slope and tibiofemoral angle were also measured. Preoperative and postoperative functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores as well as the Lysholm score.

Results: The most common factor that contributed to the failure of primary surgery was misplaced tunnels, especially on the femoral side. There were 2 patients who had grade 2 laxity preoperatively, and 15 patients had grade 3 laxity preoperatively. At the latest follow-up, all 17 patients had grade 1 laxity. On posterior stress radiography, posterior displacement improved from 10.8 ± 2.1 mm preoperatively to 2.9 ± 1.1 mm at the latest follow-up (P < .001). The IKDC subjective score improved from 34.9 ± 6.8 preoperatively to 75.3 ± 15.7 postoperatively (P < .001), and the Lysholm score improved from 38.1 ± 10.0 preoperatively to 88.5 ± 7.6 postoperatively (P < .001). All patients reached the minimal clinically important difference (MCID) for the Lysholm score, and 94% reached the MCID for the IKDC subjective score, with 65% reaching the Patient Acceptable Symptom State.

Conclusion: According to the findings of this study, arthroscopic revision PCL reconstruction with a single-bundle transtibial autograft offered satisfactory outcomes at midterm follow-up.

Keywords: PCL; failure; knee; posterior cruciate ligament; revision; single-bundle; transtibial.