Posterior Cruciate Ligament Revision Reconstruction, Part 2

Abstract

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 tendonpatellar 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 preoperatively 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.