scholarly journals Arthroscopic Repair of “Peel-Off” Lesion of the Posterior Cruciate Ligament at the Femoral Condyle

2014 ◽  
Vol 3 (1) ◽  
pp. e149-e154 ◽  
Author(s):  
Federica Rosso ◽  
Salvatore Bisicchia ◽  
Annunziato Amendola
Keyword(s):  
Posterior Cruciate Ligament ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Arthroscopic Repair

scholarly journals Graft position at the femoral condyle affects knee mobility after posterior cruciate ligament replacement

The Knee ◽  
2022 ◽  
Vol 34 ◽  
pp. 118-123
Author(s):  
Sabrina Sandriesser ◽  
Katarina Ruehlicke ◽  
Peter Augat ◽  
Daniel Hensler
Keyword(s):  
Posterior Cruciate Ligament ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Ligament Replacement

scholarly journals Arthroscopic Repair of Proximal Posterior Cruciate Ligament Injuries in Pediatric Patients

2019 ◽  
Vol 8 (7) ◽  
pp. e691-e695 ◽  
Author(s):  
Gabriele Pisanu ◽  
João Luís Moura ◽  
Adnan Saithna ◽  
Bertrand Sonnery-Cottet
Keyword(s):  
Posterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Arthroscopic Repair ◽  
Ligament Injuries

scholarly journals Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Melinda K. Harman ◽  
Stephanie J. Bonin ◽  
Chris J. Leslie ◽  
Scott A. Banks ◽  
W. Andrew Hodge
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Entire Cohort ◽  
Total Knee ◽  
And Function

Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee(96±7)and function(92±13)scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged124˚±9˚, with 126 knees exhibiting≥120°flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.

scholarly journals Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Juan Ignacio Agotegaray ◽  
Ignacio Comba ◽  
Luciana Bisiach ◽  
María Emilia Grignaffini
Keyword(s):  
Vascular Surgery ◽  
Posterior Cruciate Ligament ◽  
Popliteal Artery ◽  
Cruciate Ligament ◽  
Vascular Complications ◽  
Arthroscopic Repair ◽  
Vascular Lesions ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation

Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

Anatomic Femoral Tunnels in Posterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Marc Tompkins ◽  
Thomas C. Keller ◽  
Matthew D. Milewski ◽  
Cree M. Gaskin ◽  
Stephen F. Brockmeier ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Third Party ◽  
Pcl Reconstruction ◽  
Femoral Tunnel Drilling ◽  
Inside Out ◽  
Tunnel Angle ◽  
Bending Angles

Background: During posterior cruciate ligament (PCL) reconstruction, the placement and orientation of the femoral tunnel is critical to postoperative PCL function. Purpose: To compare the ability of outside-in (OI) versus inside-out (IO) femoral tunnel drilling in placing the femoral tunnel aperture within the anatomic femoral footprint of the PCL, and to evaluate the orientation of the tunnels within the medial femoral condyle. Study Design: Controlled laboratory study. Methods: Ten matched pairs of cadaver knees were randomized such that within each pair, 1 knee underwent arthroscopic OI drilling and the other underwent IO drilling. All knees underwent computed tomography (CT) both pre- and postoperatively with a technique optimized for ligament evaluation (80 keV with maximum mAs). Commercially available third-party software was used to fuse the pre- and postoperative CT scans, allowing comparison of the PCL footprint to the drilled tunnel. The percentage of tunnel aperture contained within the native footprint, as well as the distance from the center of the tunnel aperture to the center of the footprint, were measured. In addition, the orientation of the tunnels in the coronal and axial planes was evaluated. Results: The OI technique placed 70.4% ± 23.7% of the tunnel within the native femoral footprint compared with 79.8% ± 16.7% for the IO technique ( P = .32). The OI technique placed the center of the femoral tunnel 4.9 ± 2.2 mm from the center of the native footprint compared to 5.3 ± 2.0 mm for the IO technique ( P = .65). The femoral tunnel angle in the coronal plane was 21.0° ± 9.9° for the OI technique and 37.0° ± 10.3° for the IO technique ( P = .002). The tunnel angle in the axial plane was 27.3° ± 4.8° for the OI technique and 39.1° ± 11.5° for the IO technique ( P = .01). Conclusion: This study demonstrates no difference in the ability of the OI and IO techniques to place the femoral tunnel within the PCL femoral footprint during PCL reconstruction. With the technique parameters used in this study, the IO technique created femoral tunnels with a more vertical and anterior orientation than the OI technique. Clinical Relevance: Either technique can be used to place the femoral tunnel within the anatomic footprint. Consideration should be given to tunnel orientation following each technique, and what effect it has on graft bending angles, as these characteristics may affect graft strain and, ultimately, graft failure. In this regard, the IO technique likely produces gentler graft bending angles.

Radiographic Landmarks for Tunnel Positioning in Posterior Cruciate Ligament Reconstructions

2012 ◽  
Vol 41 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Adam M. Johannsen ◽  
Colin J. Anderson ◽  
Coen A. Wijdicks ◽  
Lars Engebretsen ◽  
Robert F. LaPrade
Keyword(s):  
Posterior Cruciate Ligament ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Joint Line ◽  
Medial Femoral Condyle ◽  
Anatomic Reconstruction ◽  
Tunnel Placement ◽  
Radiographic Measurements ◽  
Radiographic Landmarks

Background: Consistent radiographic guidelines for tunnel placement in single- or double-bundle posterior cruciate ligament (PCL) reconstructions are not well defined. Quantitative guidelines reporting the location of the individual PCL bundle attachments would aid in intraoperative tunnel placement and postoperative assessment of a PCL reconstruction. Hypothesis: Consistent and reproducible measurements in relation to radiographic landmarks for the entire PCL and its individual bundle attachments are achievable. Study Design: Controlled laboratory study. Methods: The femoral and tibial PCL bundle attachment centers of 20 nonpaired fresh-frozen cadaveric knees were labeled using radio-opaque spheres and the attachment areas were labeled using barium sulfate. Anteroposterior (AP) and lateral radiographs of the femur and tibia were obtained, and measurements of the distances between the PCL bundle centers and landmarks were acquired. Results: On the AP femur view, the anterolateral bundle (ALB) and posteromedial bundle (PMB) centers were 34.1 ± 3.0 mm and 29.2 ± 3.0 mm lateral to the most medial border of the medial femoral condyle, respectively. The lateral femur images revealed that the ALB center was 17.4 ± 1.7 mm and the PMB center was 23.9 ± 2.7 mm posteroproximal to a line perpendicular to the Blumensaat line that intersected the anterior margin of the medial femoral condyle cortex. Anteroposterior tibia images revealed that the ALB and PMB centers were located 0.2 ± 2.1 mm proximal and 4.9 ± 2.9 mm distal to the proximal joint line, respectively. The PCL attachment center was 1.6 ± 2.5 mm distal to the proximal joint line. On the lateral tibia view, the ALB center was 8.4 ± 1.8 mm, the PCL attachment center was 5.5 ± 1.7 mm, and the PMB center was 2.5 ± 1.5 mm superior to the champagne glass drop-off of the posterior tibia. Conclusion: Radiographic measurements from several clinically relevant views of the femur and tibia were reproducible with regard to the anatomic locations of the ALB and PMB centers. The measurements from the lateral femur and tibia views provided the most clinically pertinent radiographic measurements intraoperatively. Clinical Relevance: This study established a set of clinically relevant radiographic guidelines for anatomic reconstruction of the PCL. The parameters set forth in this study can be used in both the intraoperative and postoperative settings for both single- and double-bundle PCL reconstructions.

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