J Knee Surg
Departamento de Biomecanica, Medicina e Reabilitacao do Aparelho Locomotor, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, Brazil.
Published: October 2019
Posterior cruciate ligament (PCL) injuries are generally associated with high-energy trauma. There are many controversies regarding optimal surgical technique in regard to graft selection and fixation methods. The recently described onlay technique allows for direct fixation of a hamstring autograft to the posterior aspect of the tibia with cancellous screw and spiked washer, while protecting the neurovascular structures and avoiding the so-called "killer turn." The objective of this study was to compare immediate postimplantation biomechanics of unicortical versus bicortical tibial fixation of onlay PCL grafts. Eight knees were randomly assigned to one of two onlay PCL techniques ( = 4 knees/technique), performed by a single experienced surgeon. Testing consisted of a posterior-directed force at four knee flexion angles, 10, 30, 60, and 90 degrees, to measure load to 5 mm of posterior displacement, maximum displacement (at 100 N load), and stiffness. For statistical analyses, data for each knee were normalized to the native PCL-intact knee and were then grouped into unicortical or bicortical groups accordingly. Data for load to 5 mm (strength), displacement at 100 N, and stiffness were compared among PCL-intact, PCL-deficient, unicortical fixation, and bicortical fixation categories using one-way analysis of variance to assess for statistically significant ( < 0.05) differences. When compared with PCL-deficient knees, both fixation techniques had less laxity. When compared with PCL-intact knees, unicortical had more laxity at all angles, and bicortical had more laxity only at 90 degrees ( < 0.001). For relative graft strength, intact knees required significantly higher loads than both treatment groups. Bicortical, however, outperformed unicortical at all angles ( < 0.001) for relative strength. Regarding stiffness, there were no significant differences between unicortical and bicortical, and both were superior to PCL-deficient and inferior to PCL-intact knees. Based on cadaveric biomechanical testing, none of the reconstructed PCL knees was able to replicate the intact native PCL, but both techniques were superior to PCL-deficient knees. The bicortical tibial fixation technique appears to have biomechanical advantages when opting for onlay PCL reconstruction.
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http://dx.doi.org/10.1055/s-0038-1672205 | DOI Listing |
Front Bioeng Biotechnol
January 2025
Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical Universit, Guangzhou, China.
Objective: The aim of this study is to assess the kinematic changes in the knee joint during walking in patients with isolated PCL-deficiency (PCLD) to determine the presence of walking-related joint instability (mechanical instability-abnormal displacement form structural damage). Additionally, the study seeks to provide biomechanical insights into the observed differences between subjective and objective assessments.
Methods: 35 healthy volunteers and 27 patients with isolated PCLD (both involved and uninvolved sides) were included in the study.
Orthop J Sports Med
January 2025
Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Background: Graft selection is an important part of preoperative planning for anterior cruciate ligament reconstruction (ACLR). In addition, ACLR with the remnant preservation technique has recently gained attention due to potential benefit in bone-tendon healing, graft revascularization, and proprioceptive nerve remodeling. However, the ideal graft choice remains controversial, and there is limited research comparing autograft and allograft in ACLR with remnant preservation.
View Article and Find Full Text PDFKnee Surg Sports Traumatol Arthrosc
January 2025
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany.
Purpose: The medial collateral ligament (MCL), and posterior oblique ligament (POL) are the primary valgus stabilisers of the knee, and clinical examinations in grading valgus instability can be inherently subjective. Stress radiography of medial-sided knee injuries provides objective diagnosis and was analysed in this study. We hypothesised that (1) medial joint space opening would increase cutting the superficial MCL (sMCL), POL and anterior cruciate ligament (ACL); (2) isolated deep MCL (dMCL) injury would not increase medial joint space opening; (3) medial joint space opening would increase at higher flexion angles.
View Article and Find Full Text PDFJ Orthop Surg Res
January 2025
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, R.O.C, No. 201, Sec. 2, Shih-Pai Road, Beitou District, 112, Taipei, Taiwan.
Background: Tunnel enlargement (TE) might jeopardize knee function and ligament stability after revision surgery of anterior cruciate ligament reconstruction. To date, only few studies concern TE following posterior cruciate ligament reconstruction (PCLR). This study aims to determine TE after isolated PCLR and its relationship with patient-reported outcomes.
View Article and Find Full Text PDFCureus
December 2024
Orthopedic Surgery, Sengkang General Hospital, Singapore, SGP.
Background: Femoral condyle insufficiency fractures following total knee arthroplasty (FCIF-TKA) are rare but significant complications. These fractures, characterized by atraumatic bone insufficiency near the femoral component, present unique challenges in postoperative care, often necessitating femoral component revision.
Methods: This study retrospectively reviewed 835 primary total knee arthroplasties performed by a single surgeon, identifying six cases of FCIF-TKA.
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