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Posterior Cruciate

Vishal Mehta, Timothy Petsche, Ashish M Rawal
PURPOSE: To determine the inter- and intrarater reliability of the clock-face grading system as used by 3 fellowship-trained sports medicine surgeons. METHODS: Arthroscopic video was taken of the femoral tunnel placement during 20 consecutive anterior cruciate ligament (ACL) reconstructions performed by 2 surgeons. All femoral tunnels were created using a medial portal technique. The video was taken using a 30° arthroscope placed in the lateral portal and showed the femoral tunnel as well as the remainder of the femoral notch, the posterior cruciate ligament, and the menisci for orientation...
October 19, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Byung Hoon Lee, Dong Ho Kum, Im Joo Rhyu, Youngjun Kim, Hyunchul Cho, Joon Ho Wang
PURPOSE: To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR). METHODS: Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group)...
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Steven T Hendrix, Austin M Barrett, Bopha Chrea, William H Replogle, Josie M Hydrick, Gene R Barrett
Is there a correlation between increased posterior-inferior tibial slope angle and noncontact anterior cruciate ligament (ACL) injury? Does increasing the posterior-inferior tibial slope angle increase the risk of bilateral ACL injury? A computerized relational database (Access 2007; Microsoft Inc, Redmond, Washington) was used to conduct a retrospective review of patients undergoing bilateral or unilateral ACL reconstruction surgery or treatment by a single surgeon between 1995 and 2013. Included in the study were patients with bilateral and unilateral ACL injuries and patellofemoral pain syndrome with no associated ACL deficiency...
October 18, 2016: Orthopedics
Qing-Hang Zhang, Andrew Cossey, Jie Tong
Periprosthetic bone strain distributions in some of the typical cases of total knee replacement (TKR) were studied with regard to the selection of material, design and the alignments of tibial components to examine which conditions are more forgiving than the others to stress shielding post a TKR. Four tibial components with two implant designs (cruciate sacrificing and cruciate retaining) and material properties (metal-backed (MB) and all-polyethylene (AP)) were considered in a specimen-specific finite element tibia bone model loaded in a neutral position...
October 10, 2016: Medical Engineering & Physics
Guido Wierer, Armin Runer, Peter Gföller, Christian Fink, Christian Hoser
BACKGROUND: Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction. METHODS: Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy...
October 12, 2016: Knee
C Belvedere, A Ensini, M d'Amato, P Barbadoro, A Leardini
PURPOSE: Physiological elongation and orientation of patellar tendon fibres are among the scopes of total knee arthroplasty, but little is known in the three dimensions. The study aims to assess in vitro these variations at the intact and replaced knee, with and without patellar resurfacing. It was hypothesised that fibre patterns differ before and after prosthesis implantation, and between specific prosthesis designs. It was also expected that patellar resurfacing would affect relevant results...
October 13, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Paul Rothenberg, Luis Grau, Lee Kaplan, Michael G Baraga
Football has the highest injury rate amongst popular American sports. Of those injuries that end seasons or careers, the knee is the most common culprit. This is of particular concern because knee injuries are most common in football. This article reviews 4 of the most common knee injuries in American football, with emphasis on epidemiology, risk factors, and treatment outcomes. The injuries reviewed are tears of the anterior cruciate ligament, medial collateral ligament, medial patellofemoral ligament, and posterior cruciate ligament...
September 2016: American Journal of Orthopedics
Ozkan Kose, Selahattin Ozyurek, Adil Turan, Ferhat Guler
Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament (PCL) rupture and medial meniscal tear. Herein, we describe a case with reverse Segond fracture associated with PCL avulsion fracture instead of PCL rupture. According to current literature review, reverse Segond fracture is not only associated with PCL and medial meniscal injuries, but also frequently associated with anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries...
October 7, 2016: Acta Orthopaedica et Traumatologica Turcica
Yohei Shimokochi, Jatin P Ambegaonkar, Eric G Meyer
CONTEXT:  Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown. OBJECTIVE:  To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing...
October 10, 2016: Journal of Athletic Training
Mathieu Thaunat, Jean Marie Fayard, Tales M Guimaraes, Nicolas Jan, Colin G Murphy, Bertrand Sonnery-Cottet
Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25° curved suture hook device is described...
August 2016: Arthroscopy Techniques
Al-Amin M Kassam, Peter J Schranz, Vipul I Mandalia
Anatomic anterior cruciate ligament reconstruction has been shown to reduce the risk of graft failure and to improve patient-related clinical outcomes. The posterior border of the anterior horn of the lateral meniscus is a useful marker for anatomic tibial tunnel placement. Assessment of a preoperative magnetic resonance imaging scan can allow surgical planning of tibial tunnel placement to allow for anatomic, patient-specific tibial tunnel placement during anatomic anterior cruciate ligament reconstruction...
August 2016: Arthroscopy Techniques
Robert Petretta, Vipul Mandalia
The use of an accessory posteromedial portal for posterior cruciate ligament reconstruction in bicruciate knee ligament reconstruction has often been described. However, the use of a posteromedial portal can be time consuming and has some inherent risks including injury to the saphenous vein or nerve. We describe our bicruciate knee ligament reconstruction using 4 exclusively anterior portals including a high anteromedial, high anterolateral, low anteromedial, and low anterolateral portals. Arthroscopy is performed using a combination of 30° and 70° arthroscopes...
August 2016: Arthroscopy Techniques
Pinkawas Kongmalai, Bancha Chernchujit
A posterior horn of medial meniscal peripheral capsular is usually associated with the anterior cruciate ligament injury. The conventional repair technique with the camera in the anterolateral portal cannot precisely restore the slope capsular synovium to the original attachment point. We present the arthroscopic technique for improving the accuracy and quality of the repair by working in the posterior compartment. When the posterolateral portal is used as the viewing portal, the accuracy of repair is improved because we can assess the full extent of the lesion and lift the sagging peripheral tissue to the more central part...
August 2016: Arthroscopy Techniques
Jon O Wright, Nathan W Skelley, Reid P Schur, Ryan M Castile, Spencer P Lake, Robert H Brophy
BACKGROUND: The microstructural organization (collagen fiber alignment) of the posterior cruciate ligament (PCL), which likely corresponds with its functional properties, has only been described qualitatively in the literature, to our knowledge. The goal of this study was to quantify the tensile mechanical and microstructural properties of the PCL and compare these qualities between the anterolateral and posteromedial bundles. METHODS: Twenty-two knee specimens from 13 donors (8 male and 5 female; mean age [and standard deviation] at the time of death, 43...
October 5, 2016: Journal of Bone and Joint Surgery. American Volume
Michael D Ringler, Ezekiel E Shotts, Mark S Collins, B Matthew Howe
OBJECTIVE: Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. MATERIALS AND METHODS: Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture...
October 4, 2016: Skeletal Radiology
Shinichi Yoshiya
When considering the femoral attachment location for an anterolateral ligament reconstruction, the femoral attachment site should be positioned proximally and posteriorly to the lateral epicondyle to restore the physiologic length change of the native ligament. However, the clinical significance of the anterolateral ligament in patients having anterior cruciate ligament reconstructive surgery remains controversial.
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Lauren A Beaupre, B Sharifi, D W C Johnston
BACKGROUND: This 10-year follow-up compares health-related quality of life (HRQL) and reoperations in 100 subjects who were randomized to receive posterior cruciate ligament substituting (PS) or posterior cruciate ligament retaining (CR) total knee arthroplasty. We previously reported 2-year results. METHODS: Subjects were enrolled preoperatively and randomized at surgery. Subjects completed HRQL questionnaires at all evaluation points. Subjects were re-evaluated at 2 and 10 years with reoperations determined through regional medical record review and patient report...
September 8, 2016: Journal of Arthroplasty
N Jan, B Sonnery-Cottet, J-M Fayard, C Kajetanek, M Thaunat
INTRODUCTION: All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing. HYPOTHESIS: The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates. MATERIAL AND METHODS: Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair...
September 26, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Jing Xie, Chun-Li Wang, Wenbin Yang, Jue Wang, Cheng Chen, Liwei Zheng, Kl Paul Sung, Xuedong Zhou
The healing mechanism of cruciate ligaments is not well elucidated. Crosstalk between adjacent tissues in the knee joint plays an important role in wound healing and tissue regeneration, but the gelatinase modulation in posterior cruciate ligament fibroblasts (PCLfs) and synovial cells (SCs) based on co-culture is still elusive. In this study, we systematically elucidated the gelatinase modulation in both PCLfs and SCs based on in vitro co-culture and in a rabbit PCL-injury model in vivo. We found that injured PCLfs and SCs can secrete high gelatinases after co-culture...
September 29, 2016: Journal of Tissue Engineering and Regenerative Medicine
Jung-Ro Yoon, Chan-Deok Park, Dae-Hee Lee
PURPOSE: This study examined the clinical outcomes of a newly developed technique, arthroscopic suture bridge fixation with crossover ties of PCL tibial avulsion fracture using two tibial tunnels and a posterior trans-septal portal. METHODS: Records were reviewed of 18 patients (median age 33.5 years, range 13-55 years) with PCL tibial avulsion fractures treated with an arthroscopic suture bridge technique. Knee function before surgery and at last follow-up was evaluated by Lysholm and Tegner scores...
September 28, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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