Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries

Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.

Post-operative Physiotherapeutic Rehabilitation in a Rare Case of Avulsion Fracture of Tibial Attachment of Posterior Cruciate Ligament: A Case Report

Avulsion fractures of tibial attachment of PCL are not observed very often. PCL injuries are uncommon; especially those involving tibial aspect/fragment are rare. On the basis of the site of damage: Hyperflexion, Hyperextension, Pretibial trauma, etc. are the considered causes of injury. Injury to the PCL results changes in the kinematics of the knee. Changes in contact pressure have been demonstrated in both the patellofemoral and the medial tibiofemoral compartments after sectioning of the PCL, with significant increase in joint forces. This alteration in the normal kinematics may explain the tendency for the development of degenerative changes in the above mentioned compartments after PCL injury. Physiotherapy plays a very vital role in the treatment and management of such cases. Here, we report a case of a 25year old young man who was admitted to Acharya Vinobha Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS), Deemed to be University (DU), with an alleged history of slip and fall from two-wheeler due to RTA sustaining injury to the right limb, particularly on the knee and further complained of pain & swelling over the knee along with difficulty in walking. On examination and investigation it was diagnosed as the case of avulsion fracture of tibial attachment of PCL. And so was operated and treated with open reduction and internal fixation (ORIF). Thereafter, was referred to the Physiotherapy Department for further rehabilitation. The purpose of this study is to: Discuss the epidemiology& Operative method. Discuss the physiotherapeutic management and rehabilitation of PCL tears and their outcomes.

Three genes associated with anterior and posterior cruciate ligament injury

Aims The aim of this study was to screen the entire genome for genetic markers associated with risk for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury. Methods Genome-wide association (GWA) analyses were performed using data from the Kaiser Permanente Research Board (KPRB) and the UK Biobank. ACL and PCL injury cases were identified based on electronic health records from KPRB and the UK Biobank. GWA analyses from both cohorts were tested for ACL and PCL injury using a logistic regression model adjusting for sex, height, weight, age at enrolment, and race/ethnicity using allele counts for single nucleotide polymorphisms (SNPs). The data from the two GWA studies were combined in a meta-analysis. Candidate genes previously reported to show an association with ACL injury in athletes were also tested for association from the meta-analysis data from the KPRB and the UK Biobank GWA studies. Results There was a total of 2,214 cases of ACL and PCL injury and 519,869 controls within the two cohorts, with three loci demonstrating a genome-wide significant association in the meta-analysis: INHBA, AEBP2, and LOC101927869. Of the eight candidate genes previously studied in the literature, six were present in the current dataset, and only COL3A1 (rs1800255) showed a significant association (p = 0.006). Conclusion Genetic markers in three novel loci in this study and one previously-studied candidate gene were identified as potential risk factors for ACL and PCL injury and deserve further validation and investigation of molecular mechanisms. Cite this article: Bone Jt Open 2021;2(6):414–421.

Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic Posterior Cruciate Ligament Reconstruction: A Retrospective Observational Study

We evaluated the risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with only PCL injury. From August 2014 to December 2020, a total of 172 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (18 males and 8 females, mean age 43.62 years) and non-DVT group (108 males and 38 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analyzed. An old age (OR = 1.090; 95% CI = 1.025-1.158; P = 0.006), a high BMI (OR = 1.509; 95% CI = 1.181-1.929; P = 0.001) and an increased post-surgery D-dimer (OR = 5.034; 95% CI = 2.091-12,117; P ≤ 0.001) value were significantly associated with an elevated DVT risk after knee arthroscopic PCL reconstruction. Increased age, BMI, and postoperative D-dimer were risk factors of DVT following knee arthroscopic PCL reconstruction in patients with only PCL injury.

Traumatic avulsion of the anterior medial meniscus root combined with PCL injury: a case report

Background Avulsion of the anterior medial meniscus root (AMMR) has a low incidence rate, especially when it is combined with posterior cruciate ligament (PCL) injury, which hasn’t been reported in any literature to date. The aim of this study was to share our experience in the diagnosis and treatment of a patient with traumatic avulsion of AMMR combined with PCL injury. Case presentation This article reports a 26-year-old male patient diagnosed with traumatic avulsion of the AMMR with PCL injury. After arthroscopic surgery, he achieved remission of symptoms and recovery of functions. Conclusions Anterior meniscus root injuries are relatively rare. Its diagnosis can be made preliminarily based on clinical manifestations, physical examinations, and magnetic resonance imaging (MRI), and then confirmed by arthroscopic exploration. Arthroscopic suture anchor fixation of the injured anterior meniscus horn shows a good therapeutic effect.

Comparison of the effect of the graft with double strands peroneus longus tendon and with the four strands hamstring tendon on reconstruction of the posterior cruciate ligament injury

Background This prospective study was to analyze the clinical effect of double-stranded long peroneal tendon and the four strands hamstring tendon in reconstruction of posterior cruciate ligament (PCL), and to investigate the effectiveness and safety of the two surgical approaches in reconstruction of PCL, so as to provide guidance for clinical treatment of PCL injury. Methods Total 48 patients with complete rupture of PCL treated in our hospital from July 2015 to February 2017 were selected and divided into the Group A (reconstructed with double strands peroneus longus tendon, 25 cases) and the Group B (four strands hamstring tendon, 23 cases) according to the different grafts. Results The intraoperative time for tendon extraction in the Group A (20.87 ± 2.07 min) was significantly shorter than that in the Group B (26.79 ± 2.32 min). Compared with pre-operation, the tibial posterior displacement of the two groups decreased significantly 24 months after operation, and IKDC score, Lysholm score and Tegner score increased significantly. Nevertheless, the IKDC score, Lysholm score, Tegner score, AOFAS score and Maryland score between the two groups before and after operation were no significant differences. Compared with the quadrupled hamstring tendon, the double-stranded peroneal longus tendon has the advantages of simple and safe tendon extraction. Conclusions Both surgical methods are effective for the treatment of PCL injury. When the four strands hamstring tendon is accidental (tendon rupture or tendon variation) or ineffective, the peroneal longus tendon will be a good choice.

Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

Common risk factors of deep vein thrombosis after arthroscopic posterior cruciate ligament reconstruction: a 5-year retrospective study

Background To analyse the common risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with PCL injury. Methods From August 2014 to December 2019, a total of 86 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (9 males and 4 females, mean age 43.62 years) and non-DVT group (54 males and 19 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analysed. Results High BMI and post-surgery D-dimer values were significantly associated with DVT risk. Conclusions Increased BMI and postoperative D-dimer levels are risk factors of DVT following knee arthroscopic PCL reconstruction in patients with PCL injury.

A Positive Quadriceps Active Test, without the Quadriceps Being Active

Case. A 55-year-old male with a chronic isolated grade 3 PCL injury who demonstrates a positive quadriceps active test without activating his quadriceps musculature. Conclusion. Gravity and hamstring contraction posteriorly translate the tibia into a subluxed position. Subsequent gastrocnemius contraction with the knee flexed causes an anterior tibial translation by virtue of the mass enlargement of the gastrocnemius muscular bulk, the string of a bow effect, and the anterior origin of the gastrocnemius in relation to the posterior border of the subluxed tibia aided by the normal posterior tibial slope.