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Document Title: Davis-AJSM-Jul06.shtml
Article Title: Anatomical Posterior Cruciate Ligament Transplantation -- A Biomechanical Analysis
Authors: Daniel K. Davis, MD, David H. Goltz, MD, Donald C. Fithian, MD and Darryl D’Lima, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: July 2006.
Volume 34, pages 1126-1133
Keywords: Knee biomechanics, arthroscopy, arthroscopic surgery, PCL kinematics, knee motion, allografting, knee instability, roll-and-glide motion of knee as defined by cruciate ligaments acting together.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This study shows the urgent need for improved methods of PCL reconstruction. The goal is not only to restore knee stability in the PCL-deficient person, but rather to also restore normal or near-normal knee motion. (Normal knee motion is a complex combination involving roll and glide, and is defined by the cruciate ligaments.) The authors look specifically at femoral rollback, and note that the two current PCL-reconstruction methods (single-bundle and double-bundle) still do not restore normal knee kinematics. The double-bundle method of PCL reconstruction is better than the single-bundle one, but problems remain. The PCL, like the ACL, has a complex, multifascicular construction, and has flared ends. These attributes make the anatomically accurate reconstruction of this ligament an inherently extremely daunting task. Therefore, with any graft constructs and installations, the goal is to come as close to normal knee motion and function (including kinematics and biomechanics) as is realistically possible.
ABSTRACT
Background: Although current techniques of posterior cruciate ligament reconstruction may successfully stabilize the posterior cruciate ligament–deficient knee, no studies have demonstrated restoration of intact-knee kinematics.
Hypothesis: Posterior cruciate ligament transplantation will successfully restore posterior stability and kinematics to the posterior cruciate ligament–deficient knee.
Study Design: Controlled laboratory study.
Methods: Seven pairs (donor/recipient) of size-matched cadaveric knees underwent a novel technique for posterior cruciate ligament transplantation. The grafts were fixed at the femoral origin and tibial insertion using an inlay technique with rigid fixation. The knees were tested in the intact (intact group), posterior cruciate ligament–deficient (deficient group), and posterior cruciate ligament–transplanted (transplant group) states. A 3-dimensional electromagnetic tracking system during an active knee extension and passive knee flexion maneuver was used to quantify kinematics, specifically looking at femoral rollback. KT ligament arthrometry was used to quantify posterior stability at the quadriceps neutral angle (70°).
Results: For femoral rollback, the intact versus deficient groups was significantly different (P = .045) as was deficient versus transplant groups (P = .008) but not intact versus transplant groups. Similar differences were noted with the measurements of posterior stability (P < .001). Total posterior laxity between the intact versus deficient groups was significantly different (means, 1.32 mm vs 11.1 mm; P < .0001), as was deficient versus transplant groups (means, 11.1 mm vs 2.04 mm; P < .126) but not intact versus transplant groups.
Conclusion: In a posterior cruciate ligament–deficient cadaveric model, we demonstrated the technical feasibility and efficacy of posterior cruciate ligament transplantation for restoring femoral rollback and posterior stability at the quadriceps neutral angle.
Clinical Relevance: Future studies in posterior cruciate ligament reconstruction should not only address stability but also restoration of normal knee kinematics in assessing the success of a given technique.
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