Second Look Findings after Arthroscopic Posterior Cruciate Ligament Reconstruction

Jung, Young Bok; Chang, Eui Chan; Yum, Jae Kwang

Abstract

Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.