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Anatomical Posterior Cruciate Ligament Transplantation

A Biomechanical Analysis

Daniel K. Davis, MD^*,, David H. Goltz, MD, Donald C. Fithian, MD and Darryl D’Lima, MD^||

From the Simi Orthopedics and Sports Medicine, Simi Valley, California, Mt. Tam Orthopedics, Larkspur, California, Southern California Permanente Medical Group, El Cajon, California, and the ^|| Shiley Center for Orthopaedic Research & Education at Scripps Clinic, San Diego, California

^* Address correspondence to Daniel K. Davis, MD, 2750 North Sycamore Drive, Suite 210, Simi Valley, CA 93065 (e-mail: Osteodan{at}aol.com).

Background: Although current techniques of posterior cruciate ligament reconstruction may successfully stabilize the posterior cruciate ligament–deficient knee, no studies have demonstrated restoration of intact-knee kinematics.

Hypothesis: Posterior cruciate ligament transplantation will successfully restore posterior stability and kinematics to the posterior cruciate ligament–deficient knee.

Study Design: Controlled laboratory study.

Methods: Seven pairs (donor/recipient) of size-matched cadaveric knees underwent a novel technique for posterior cruciate ligament transplantation. The grafts were fixed at the femoral origin and tibial insertion using an inlay technique with rigid fixation. The knees were tested in the intact (intact group), posterior cruciate ligament–deficient (deficient group), and posterior cruciate ligament–transplanted (transplant group) states. A 3-dimensional electromagnetic tracking system during an active knee extension and passive knee flexion maneuver was used to quantify kinematics, specifically looking at femoral rollback. KT ligament arthrometry was used to quantify posterior stability at the quadriceps neutral angle (70°).

Results: For femoral rollback, the intact versus deficient groups was significantly different (P = .045) as was deficient versus transplant groups (P = .008) but not intact versus transplant groups. Similar differences were noted with the measurements of posterior stability (P < .001). Total posterior laxity between the intact versus deficient groups was significantly different (means, 1.32 mm vs 11.1 mm; P < .0001), as was deficient versus transplant groups (means, 11.1 mm vs 2.04 mm; P < .126) but not intact versus transplant groups.

Conclusion: In a posterior cruciate ligament–deficient cadaveric model, we demonstrated the technical feasibility and efficacy of posterior cruciate ligament transplantation for restoring femoral rollback and posterior stability at the quadriceps neutral angle.

Clinical Relevance: Future studies in posterior cruciate ligament reconstruction should not only address stability but also restoration of normal knee kinematics in assessing the success of a given technique.

Key Words: posterior cruciate ligament • knee injury • allograft • transplantation • knee instability