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Year 2015, , 579 - 585, 28.10.2015
https://doi.org/10.3944/AOTT.2015.14.0443

Abstract

Amaç: Açık tibiyal inley tekniği ile izole ya da tek aşamalı kombine arka çapraz bağ rekonstrüksiyonu uygulanan hastalarda klinik deneyimlerimizi sunmayı amaçladık.Çalışma planı: Tibiyal inley tekniği ile AÇB rekonstrüksiyonu uygulanan 17 hastanın kayıtları retrospektif olarak değerlendirilmiştir. Tek taraflı femoral ya da tibial osteokondral kopma kırığı ya da tek taraflı eşzamanlı tibia ve femur şaft kırığı olan hastalar çalışma dışı bırakılmıştır. İki hastada izole arka çapraz bağ rekonstrüksiyonu gerçekleştirilirken, 10/17 hastada posterolateral köşe rekonstrüksiyonu, 14/17 hastada ön çapraz bağ rekonstrüksiyonu ve 2/17 hastada mediyal kollateral bağ rekonstrüksiyonu ile birlikte yapılmıştır. Tüm hastalar ortalama 14.27±6.77 (6–30) ay süreyle izlenmiştir.Bulgular: Cerrahi öncesi değerlendirmelerde tüm hastalarda arka çekmece testinde arkaya gevşeklik 3 + iken son takipler sırasında yapılan değerlendirmelerde arka çekmece testi skoru 6 hastada 0 gevşeklik, 7 hastada + 1 gevşeklik ve 4 hastada + 2 gevşeklik olarak belirlenmiştir (p<0.001). IKDC objektif değerlendirmesi, preoperatif dönemde tüm hastalarda ciddi işlev kaybı göstermekle beraber, son takip değerlendirmelerde 5 dizin A düzeyde, 8 dizin B düzeyde, 3 dizin C düzeyde ve 1 dizin ise D düzeyde olduğunu göstermiştir. Ortalama IKDC subjektif skoru izlemlerde 75.22±7.53 olarak belirlenmiştir. Postoperatif dönemde, KT-1000 artrometresindeki ortalama iki taraf farkı 2.45±1.80 mm olarak ölçülmüştür. Son izlemde ortalama ROM ekstansiyonda 0 derece ve fleksiyonda 123.56±6.31 olarak saptanmıştır.Çıkarımlar: Açık tibiyal inley yaklaşımı arka çapraz bağ rekonkstrüksiyonunda yararlıdır. Fonksiyonel sonuçlar üzerindeki etkinliğini ve komplikasyonlara karşı güvenilirliğini belirlemek için yeni çalışmalara ihtiyaç vardır

References

  • Parkkari J, Pasanen K, Mattila VM, Kannus P, Rimpelä A. The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up. Br J Sports Med 2008;42:422,6.
  • Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc 2013;45:462–9.
  • Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDon- ald PA, Boyd JL, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009;17:197–206.
  • Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cru- ciate ligament injury treated nonoperatively. Am J Sports Med 2013;41:1526–33.
  • Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 2009;37:471–80.
  • Kim YM, Lee CA, Matava MJ. Clinical results of ar- throscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 2011;39:425–34.
  • Gancel E, Magnussen RA, Lustig S, Demey G, Neyret P, Servien E. Tunnel position following posterior cruciate ligament reconstruction: an in vivo computed tomography analysis. Knee 2012;19:450–4.
  • Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 2012;40:222–31.
  • McAllister DR, Hussain SM. Tibial inlay posterior cru- ciate ligament reconstruction: surgical technique and re- sults. Sports Med Arthrosc 2010;18:249–53.
  • Shon OJ, Lee DC, Park CH, Kim WH, Jung KA. A com- parison of arthroscopically assisted single and double bun- dle tibial inlay reconstruction for isolated posterior cruci- ate ligament injury. Clin Orthop Surg 2010;2:76–84.
  • Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Or- thop Relat Res 1990;254:216–9.
  • Jung YB, Jung HJ, Kim SJ, Park SJ, Song KS, Lee YS, et al. Posterolateral corner reconstruction for posterolat- eral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques. Knee Surg Sports Traumatol Ar- throsc 2008;16:239–48.
  • LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Es- terberg JL, Tso A. An analysis of an anatomical posterolat- eral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004;32:1405–14.
  • Cooper DE, Stewart D. Posterior cruciate ligament re- construction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up. Am J Sports Med 2004;32:346–60.
  • Ruberte Thiele RA, Campbell RB, Amendola A, Sekiya JK. Biomechanical comparison of figure-of-8 versus cylin- drical tibial inlay constructs for arthroscopic posterior cru- ciate ligament reconstruction. Arthroscopy 2010;26:977– 83.
  • Mabe I, Hunter S. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison. Cell Tissue Bank 2014;15:523–9.
  • Wajsfisz A, Christel P, Djian P. Does reconstruction of isolated chronic posterior cruciate ligament injuries re- store normal knee function? Orthop Traumatol Surg Res 2010;96:388–93.
  • Gauffin H, Rockborn P. Knee dislocations: is reconstruc- tion of the posterior cruciate ligament crucial? Eur J Or- thop Surg Traumatol 2014;24:371,7.
  • Difelice GS, Lissy M, Haynes P. Surgical technique: when to arthroscopically repair the torn posterior cruciate liga- ment. Clin Orthop Relat Res 2012;470:861–8.
  • Stannard JP, Riley RS, Sheils TM, McGwin G Jr, Volgas DA. Anatomic reconstruction of the posterior cruciate ligament after multiligament knee injuries. A combination of the tibial-inlay and two-femoral-tunnel techniques. Am J Sports Med 2003;31:196–202.
  • Chuang TY, Ho WP, Hsieh PH, Yu SW, Chen YJ, Chen CH. One-stage posterior cruciate ligament inlay reconstruction combining anterior cruciate ligament re- construction following knee dislocation. Arthroscopy 2006;22:339.e1–7.
  • Strobel MJ, Schulz MS, Petersen WJ, Eichhorn HJ. Combined anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities. Ar- throscopy 2006;22:182–92.
  • Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N. Tibial inlay for posterior cruciate ligament reconstruction: a systematic review. Knee 2010;17:2649.
  • Kim SJ, Kim SH, Kim SG, Kung YP. Comparison of the clinical results of three posterior cruciate ligament recon- struction techniques: surgical technique. J Bone Joint Surg Am 2010;92 Suppl 1 Pt 2:145–57.
  • Panchal HB, Sekiya JK. Open tibial inlay versus ar- throscopic transtibial posterior cruciate ligament recon- structions. Arthroscopy 2011;27:1289–95.
  • MacGillivray JD, Stein BE, Park M, Allen AA, Wickie- wicz TL, Warren RF. Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate liga- ment reconstruction: minimum 2-year follow-up. Ar- throscopy 2006;22:320–8.
  • Seon JK, Song EK. Reconstruction of isolated poste- rior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 2006;22:27–32.

Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries

Year 2015, , 579 - 585, 28.10.2015
https://doi.org/10.3944/AOTT.2015.14.0443

Abstract

Objective: The aim of this study is to report our institution’s experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction.
Methods: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6–30) months.
Results: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p<0.001). International Knee Documentation Committee (IKDC) objective evaluation showed severe disability in all patients preoperatively, whereas 5 knees were grade A, 8 knees were grade B, 3 knees were grade C, and 1 knee was grade D at final follow-up. Mean IKDC subjective score was 75.22±7.53 at final follow-up. Postoperatively, mean side-to-side difference in KT-1000 arthrometer measurement was 2.45±1.80 mm. At final follow-up, mean range of motion (ROM) was 0º on extension and 123.56±6.31º on flexion.
Conclusion: Open tibial inlay approach is beneficial during PCL reconstruction. Further study is warranted to establish its effectiveness on functional outcomes and prevention of complications.

References

  • Parkkari J, Pasanen K, Mattila VM, Kannus P, Rimpelä A. The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up. Br J Sports Med 2008;42:422,6.
  • Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc 2013;45:462–9.
  • Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDon- ald PA, Boyd JL, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009;17:197–206.
  • Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cru- ciate ligament injury treated nonoperatively. Am J Sports Med 2013;41:1526–33.
  • Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 2009;37:471–80.
  • Kim YM, Lee CA, Matava MJ. Clinical results of ar- throscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 2011;39:425–34.
  • Gancel E, Magnussen RA, Lustig S, Demey G, Neyret P, Servien E. Tunnel position following posterior cruciate ligament reconstruction: an in vivo computed tomography analysis. Knee 2012;19:450–4.
  • Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 2012;40:222–31.
  • McAllister DR, Hussain SM. Tibial inlay posterior cru- ciate ligament reconstruction: surgical technique and re- sults. Sports Med Arthrosc 2010;18:249–53.
  • Shon OJ, Lee DC, Park CH, Kim WH, Jung KA. A com- parison of arthroscopically assisted single and double bun- dle tibial inlay reconstruction for isolated posterior cruci- ate ligament injury. Clin Orthop Surg 2010;2:76–84.
  • Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Or- thop Relat Res 1990;254:216–9.
  • Jung YB, Jung HJ, Kim SJ, Park SJ, Song KS, Lee YS, et al. Posterolateral corner reconstruction for posterolat- eral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques. Knee Surg Sports Traumatol Ar- throsc 2008;16:239–48.
  • LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Es- terberg JL, Tso A. An analysis of an anatomical posterolat- eral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004;32:1405–14.
  • Cooper DE, Stewart D. Posterior cruciate ligament re- construction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up. Am J Sports Med 2004;32:346–60.
  • Ruberte Thiele RA, Campbell RB, Amendola A, Sekiya JK. Biomechanical comparison of figure-of-8 versus cylin- drical tibial inlay constructs for arthroscopic posterior cru- ciate ligament reconstruction. Arthroscopy 2010;26:977– 83.
  • Mabe I, Hunter S. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison. Cell Tissue Bank 2014;15:523–9.
  • Wajsfisz A, Christel P, Djian P. Does reconstruction of isolated chronic posterior cruciate ligament injuries re- store normal knee function? Orthop Traumatol Surg Res 2010;96:388–93.
  • Gauffin H, Rockborn P. Knee dislocations: is reconstruc- tion of the posterior cruciate ligament crucial? Eur J Or- thop Surg Traumatol 2014;24:371,7.
  • Difelice GS, Lissy M, Haynes P. Surgical technique: when to arthroscopically repair the torn posterior cruciate liga- ment. Clin Orthop Relat Res 2012;470:861–8.
  • Stannard JP, Riley RS, Sheils TM, McGwin G Jr, Volgas DA. Anatomic reconstruction of the posterior cruciate ligament after multiligament knee injuries. A combination of the tibial-inlay and two-femoral-tunnel techniques. Am J Sports Med 2003;31:196–202.
  • Chuang TY, Ho WP, Hsieh PH, Yu SW, Chen YJ, Chen CH. One-stage posterior cruciate ligament inlay reconstruction combining anterior cruciate ligament re- construction following knee dislocation. Arthroscopy 2006;22:339.e1–7.
  • Strobel MJ, Schulz MS, Petersen WJ, Eichhorn HJ. Combined anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities. Ar- throscopy 2006;22:182–92.
  • Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N. Tibial inlay for posterior cruciate ligament reconstruction: a systematic review. Knee 2010;17:2649.
  • Kim SJ, Kim SH, Kim SG, Kung YP. Comparison of the clinical results of three posterior cruciate ligament recon- struction techniques: surgical technique. J Bone Joint Surg Am 2010;92 Suppl 1 Pt 2:145–57.
  • Panchal HB, Sekiya JK. Open tibial inlay versus ar- throscopic transtibial posterior cruciate ligament recon- structions. Arthroscopy 2011;27:1289–95.
  • MacGillivray JD, Stein BE, Park M, Allen AA, Wickie- wicz TL, Warren RF. Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate liga- ment reconstruction: minimum 2-year follow-up. Ar- throscopy 2006;22:320–8.
  • Seon JK, Song EK. Reconstruction of isolated poste- rior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 2006;22:27–32.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Sinan Zehir

Nurzat Elmalı

Ercan Şahin

Murat Çalbıyık

Mustafa Karakaplan This is me

Zeki Taşdemir This is me

Publication Date October 28, 2015
Published in Issue Year 2015

Cite

APA Zehir, S., Elmalı, N., Şahin, E., Çalbıyık, M., et al. (2015). Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries. Acta Orthopaedica Et Traumatologica Turcica, 49(6), 579-585. https://doi.org/10.3944/AOTT.2015.14.0443
AMA Zehir S, Elmalı N, Şahin E, Çalbıyık M, Karakaplan M, Taşdemir Z. Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries. Acta Orthopaedica et Traumatologica Turcica. October 2015;49(6):579-585. doi:10.3944/AOTT.2015.14.0443
Chicago Zehir, Sinan, Nurzat Elmalı, Ercan Şahin, Murat Çalbıyık, Mustafa Karakaplan, and Zeki Taşdemir. “Posterior Cruciate Ligament Reconstruction via Tibial Inlay Technique in Multiligament Knee Injuries”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 6 (October 2015): 579-85. https://doi.org/10.3944/AOTT.2015.14.0443.
EndNote Zehir S, Elmalı N, Şahin E, Çalbıyık M, Karakaplan M, Taşdemir Z (October 1, 2015) Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries. Acta Orthopaedica et Traumatologica Turcica 49 6 579–585.
IEEE S. Zehir, N. Elmalı, E. Şahin, M. Çalbıyık, M. Karakaplan, and Z. Taşdemir, “Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 6, pp. 579–585, 2015, doi: 10.3944/AOTT.2015.14.0443.
ISNAD Zehir, Sinan et al. “Posterior Cruciate Ligament Reconstruction via Tibial Inlay Technique in Multiligament Knee Injuries”. Acta Orthopaedica et Traumatologica Turcica 49/6 (October 2015), 579-585. https://doi.org/10.3944/AOTT.2015.14.0443.
JAMA Zehir S, Elmalı N, Şahin E, Çalbıyık M, Karakaplan M, Taşdemir Z. Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries. Acta Orthopaedica et Traumatologica Turcica. 2015;49:579–585.
MLA Zehir, Sinan et al. “Posterior Cruciate Ligament Reconstruction via Tibial Inlay Technique in Multiligament Knee Injuries”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 6, 2015, pp. 579-85, doi:10.3944/AOTT.2015.14.0443.
Vancouver Zehir S, Elmalı N, Şahin E, Çalbıyık M, Karakaplan M, Taşdemir Z. Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries. Acta Orthopaedica et Traumatologica Turcica. 2015;49(6):579-85.