Document Title: Noyes-AJSM-May05b.shtml
Article Title: Posterior Cruciate Ligament Revision Reconstruction, Part 2 – Results of Revision Using a 2-Strand Quadriceps Tendon–Patellar Bone Autograft
Authors: Frank R. Noyes, MD and Sue D. Barber-Westin
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: May 2005
Volume 33, pages 655-665
Keywords: PCL revision reconstruction, two-stand method, quadriceps-tendon-patellar-tendon-bone autografting.

(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 intriguing article delves into the results of the complex-injury knees which underwent revision PCL reconstruction using the two-strand method (which is biomechanically far superior to a single-strand graft). Keeping in mind that the knees in this study had extensive injury histories, the results of the revision reconstructions are impressive. (Dr. Noyes is one of those few doctors who specializes in treating severe, complex knee injuries. He has done pioneering work in many aspects of knee injuries. Sue Barber-Westin, a seasoned clinical researcher of international stature, is one of the most penetratingly insightful people in the entire realm of orthopedics.)

Part 1 of this two-part set can be found here.

ABSTRACT

Background: Posterior cruciate ligament reconstructions fail for similar reasons as to why anterior cruciate ligament reconstructions fail. Revision surgery is an option after failure.

Purpose: To prospectively study the results of 15 posterior cruciate ligament revision surgeries using a 2-strand quadriceps tendon–patellar bone autograft.

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

Methods: The authors observed 15 knees that received the revision procedure a mean of 44 months (range, 23–84 months) postoperatively. The results were determined by a comprehensive knee examination including stress radiography and several grading scales. A tibial inlay technique was used in 9 knees, and an arthroscopic tibial tunnel technique was done in 6 knees. Six knees required 1 or more concomitant ligament reconstructions.

Results: Significant improvements occurred in pain, function, and patient perception scores (P < .05). However, only 53% returned to light sports without problems. Stress radiograph posterior tibial translation values improved from 11.7 ± 3.0 mm pre-operatively to 5.1 ± 2.4 mm at follow-up (P < .001). Two of the 15 revisions failed. Associated knee ligament reconstructive procedures restored anterior, medial, and posterolateral stability. There were no complications from the quadriceps tendon graft harvest site. Abnormal articular cartilage surfaces were found during the revision in 8 (53%) knees.

Conclusions: The quadriceps tendon 2-strand revision provided reasonable results in this group of complex-injured knees. The tibial inlay approach is advantageous to bypass prior tibial tunnels, and the all-inside arthroscopic technique is advantageous when major concurrent ligament reconstructions are required.

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