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Isolated and Combined Grade-III Posterior Cruciate Ligament Tears Treated with Double-Bundle Reconstruction with Use of Endoscopically Placed Femoral Tunnels and GraftsOperative Technique and Clinical Outcomes
Stanislav I. Spiridonov, MD1; Nathaniel J. Slinkard, MD1; Robert F. LaPrade, MD, PhD2
1 Department of Orthopaedic Surgery, University of Minnesota, 2515 South 7th Street, Suite R-200, Minneapolis, MN 55454
2 The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657. E-mail address: drlaprade@sprivail.org
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. One or more of the authors, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the University of Minnesota, Minneapolis, Minnesota

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Oct 05;93(19):1773-1780. doi: 10.2106/JBJS.J.01638
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Abstract

Background: 

A variety of techniques have been developed to improve clinical outcomes and objective knee stability following posterior cruciate ligament (PCL) reconstruction. Additional refinements in surgical and rehabilitation techniques are necessary for improvement of both subjective and objective outcomes.

Methods: 

All patients studied underwent endoscopic PCL reconstruction with a double-bundle allograft. All of the allografts were placed into the femoral tunnel through a lateral arthroscopic portal, secured by an all-inside method, and were passed distally through a transtibial tunnel. Modified Cincinnati subjective and International Knee Documentation Committee (IKDC) subjective and objective outcome scores and posterior stress radiographs of the knee were made preoperatively and at the time of final follow-up.

Results: 

There were a total of thirty-nine patients, including thirty-three male and six female patients, with an average age of thirty-three years. There were seven isolated PCL reconstructions and thirty-two combined reconstructions of the knee. Eight patients were not available for follow-up at a minimum of two years, leaving a cohort of thirty-one patients. Preoperative Cincinnati and IKDC subjective scores averaged 34.5 and 39.3, respectively. These scores improved significantly to 73.2 and 74.3, respectively, at an average of 2.5 years postoperatively. On posterior stress radiographs, the average posterior tibial translation of the knees was 15 mm preoperatively and improved significantly to 0.9 mm postoperatively.

Conclusions: 

Patients undergoing double-bundle PCL reconstruction with use of endoscopic placement of femoral tunnels had significant improvements in subjective and objective outcome scores and with objective knee stability.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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