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Posterior cruciate ligament reconstruction by transfer of the medial gastrocnemius tendon

Division of Orthopaedic Surgery, Victoria Hospital, University of Western Ontario and the Orthopaedic Therapy Centre, London, Ontario, Canada

Robert C. Bray, MD, FRCS C

Division of Orthopaedic Surgery, Victoria Hospital, University of Western Ontario and the Orthopaedic Therapy Centre, London, Ontario, Canada

T.M. Best

Division of Orthopaedic Surgery, Victoria Hospital, University of Western Ontario and the Orthopaedic Therapy Centre, London, Ontario, Canada

L.A. Cunning, PT

Division of Orthopaedic Surgery, Victoria Hospital, University of Western Ontario and the Orthopaedic Therapy Centre, London, Ontario, Canada

R.P. Jacobson, PT

Division of Orthopaedic Surgery, Victoria Hospital, University of Western Ontario and the Orthopaedic Therapy Centre, London, Ontario, Canada

A retrospective study to determine the efficacy of me dial gastrocnemius tendon transfer for symptomatic PCL instability is presented. Results from a group of 31 patients undergoing this procedure were compared with a group of 8 patients managed conservatively while awaiting surgery.

The mean injury to follow-up interval was 82 months in the operated group and 104 months in the nonop erated group. The mean surgery to follow-up interval was 53 months. Sixty-nine percent of surgical patients were subjectively improved; however, 29 (91 %) contin ued to have pain and 19 (59%) continued to experience giving way. Thirteen patients from the operated group who had associated procedures performed were sig nificantly better subjectively than those with no asso ciated procedures (P < 0.05).

Physical examination demonstrated no difference in clinical laxity between the operated and nonoperated groups. Medial gastrocnemius transfer did not result in any significant reduction in anterior-posterior translation (KT-1000 assessment) when reconstructed knees were compared with control posterior cruciate deficient knees. Surgery, combined with subsequent immobili zation, may have also been responsible for the signifi cant reduction in lower limb function observed in the reconstructed patients.

We do not recommend this procedure as a primary PCL reconstruction.

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