Background: Several controversies exist regarding the superiority of double-bundle (DB) posterior cruciate ligament (PCL) reconstruction versus single-bundle (SB) reconstruction, although DB reconstruction has been shown to restore the intact knee kinematics more closely than SB reconstruction.
Hypothesis: Double-bundle PCL reconstruction will present better results than SB reconstruction in postoperative outcomes.
Study Design: Randomized controlled trial; Level of evidence, 2.
Methods: The authors prospectively analyzed 25 cases of SB reconstruction and 28 cases of DB reconstruction using Achilles tendon allograft with a minimum 2-year follow-up. They compared preoperative and postoperative range of motion, posterior stability by posterior stress radiography, Tegner activity score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee evaluation form and knee examination form between the 2 groups.
Results: There was no difference in range of motion, Tegner activity score, Lysholm score, and IKDC subjective knee evaluation form between the 2 groups at last follow-up. The side-to-side difference in posterior translation significantly improved in both groups. There was no preoperative difference in posterior instability between the groups but a significant difference at last follow-up. On the IKDC knee examination form, the DB reconstruction group presented better results in grade distribution.
Conclusion: The DB reconstruction for PCL ruptures using the Achilles allograft showed better results in posterior stability and IKDC knee examination form than the SB reconstruction did. Although the difference of 1.4 mm in posterior stability was statistically significant, it is unclear that DB reconstruction is definitely superior to SB reconstruction clinically and functionally because there was no difference in the subjective scores.
Background: There is a paucity of clinical studies comparing single- and double-bundle posterior cruciate ligament (PCL) reconstruction combined with a posterolateral corner reconstruction.
Purpose: To compare the clinical outcomes of single- and double-bundle transtibial PCL reconstruction combined with reconstruction of the lateral collateral ligament and popliteus tendon for posterolateral corner insufficiency.
Study Design: Cohort study; Level of evidence 3.
Methods: The study population consisted of 42 patients for whom a minimum of 2 years of follow-up data were available. The authors compared the clinical outcomes of 2 surgical techniques: a single-bundle technique (23 patients) and a double-bundle technique (19 patients), each combined with reconstruction of the lateral collateral ligament and popliteus tendon for posterolateral corner insufficiency.
Results: There was no significant difference between the single- and double-bundle groups in mean side-to-side difference of posterior translation as measured with Telos stress radiography (4.2 ± 1.7 vs 3.9 ± 1.6 mm; P = .628). Rates of residual increased laxity greater than 5 mm were 22% in the single-bundle group and 21% in the double-bundle group. Regarding posterolateral rotatory instability, there were no differences between the 2 groups in mean side-to-side difference in the dial test (5.3° ± 2.7° vs 5.1° ± 2.4° at 30° of flexion [P = .800]; 6.7° ± 2.7° vs 6.7° ± 2.4° at 90° of flexion [P = .917]) or in varus stress radiography (1.2 ± 1.2 vs 1.3 ± 1.4 mm; P = .722). The Lysholm knee scores were 85.7 ± 7.6 in the single-bundle group and 87.7 ± 7.3 in the double-bundle group, and there was no significant difference between them (P = .392). There was also no difference between the groups in International Knee Documentation Committee knee score (P = .969); from this, the rates of abnormal and severely abnormal were 30% in the single-bundle group and 26% in the double-bundle group.
Conclusion: In this series, double-bundle PCL reconstruction combined with posterolateral corner reconstruction did not appear to have advantages over single-bundle PCL reconstruction combined with posterolateral corner reconstruction with respect to the clinical outcomes or posterior knee stability.
Background: The authors previously reported the initial results of a femoral-fibular posterolateral reconstruction in which an Achilles tendon allograft was passed through a fibular tunnel adjacent to the anatomical fibular attachment site of the fibular collateral ligament and a femoral tunnel anterior and posterior to its femoral attachment site.
Purpose: To compare the short-term results (mean, 3.5 years) to the long-term results (mean, 14 years) of posterolateral femoral-fibular knee ligament reconstructions in regard to restoration of posterolateral knee stability.
Study Design: Case series; Level of evidence, 4.
Methods: The authors report on 21 patients who underwent a posterolateral femoral-fibular reconstruction after sustaining multiligament ruptures with chronic instability. The results were determined by a comprehensive knee examination, stress radiographs, standing posteroanterior radiographs, knee arthrometer testing, the Cincinnati Knee Rating System, and the International Knee Documentation Committee rating system.
Results: In the short-term analysis, the posterolateral reconstruction restored normal or nearly normal lateral joint opening and external tibial rotation according to International Knee Documentation Committee criteria in 16 of 21 patients (76%), whereas the other 5 were deemed early failures. Fourteen of these patients were followed 10.0 to 19.4 years postoperatively. Retention of normal or nearly normal lateral joint opening and external tibial rotation was found, and there were no significant differences between evaluations for symptoms, sports and daily activity functions, overall knee ratings, and knee ligament function. At the long-term follow-up evaluation, 71% had no symptoms with low-impact sports. However, concurrent arthritis affected 14% who had symptoms with sports (but no symptoms with daily activities) and 14% who had symptoms with daily activities.
Conclusion: The long-term success rate of the femoral-fibular procedure in restoring posterolateral stability warrants consideration of this procedure, particularly in acute cases or when operative time is prolonged and a more simplified procedure is indicated.
Background: Medial opening-wedge high tibial osteotomy has been gaining popularity in recent years, and autogenous iliac crest bone is the gold standard graft; however, the surgical time, risk, and morbidity associated with its harvest are significant. The question of a satisfactory bone-graft substitute has yet to be clearly answered.
Hypothesis: A corticocancellous proximal tibial wedge allograft is a satisfactory graft choice when evaluating union in medial opening-wedge high tibial osteotomy.
Study Design: Case series; Level of evidence, 4.
Methods: Fifty consecutive patients who underwent medial opening-wedge high tibial osteotomy from May 2001 to May 2006 were included in the study. The amount of correction ranged from 5° to 17.5°, with a mean of 10.1°. Forty patients had fixation with a stainless steel plate and screws and 10 with a titanium interlocking plate and screws. The graft used in each case was a corticocancellous proximal tibial wedge allograft. No osteoinductive supplements were added. Patients started continuous passive motion immediately after surgery and began weightbearing at 8 weeks (if bone healing was progressing). Clinical and radiographic evaluation was performed monthly until full union and twice thereafter. Follow-up ranged from 5 months to 6 years, with a mean of 2.1 years.
Results: The average time to bone union was 12.1 weeks (range, 8–24). Two patients (4%) had a nonunion, defined as not healed at 6 months. Only 1 patient (a nonunion patient) had loss of correction at the osteotomy site, defined as collapse of the opening wedge (this occurred at 6 months after surgery). There were no cases of infection, no wound-healing problems, no cases of arthrofibrosis, and no neurovascular injuries.
Conclusion: When union is assessed, a corticocancellous proximal tibial wedge allograft is a satisfactory graft choice in medial opening-wedge high tibial osteotomy.
