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Posterior Cruciate Ligament Revision Reconstruction, Part 2

Results of Revision Using a 2-Strand Quadriceps Tendon–Patellar Bone Autograft

From the Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio

^* Address correspondence to Sue D. Barber-Westin, c/o Cincinnati Sportsmedicine Research and Education Foundation, Deaconess Hospital, 311 Straight Street, Cincinnati, OH 45219 (e-mail: sbwestin{at}smref.org).

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.

Key Words: posterior cruciate ligament (PCL) • revision

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				K. L. Markolf, B. T. Feeley, S. R. Jackson, and D. R. McAllister Biomechanical Studies of Double-Bundle Posterior Cruciate Ligament Reconstructions J. Bone Joint Surg. Am., August 1, 2006; 88(8): 1788 - 1794. [Abstract] [Full Text] [PDF]