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Published in: Archives of Orthopaedic and Trauma Surgery 6/2016

01-06-2016 | Arthroscopy and Sports Medicine

Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries?

Authors: Soyeon Ahn, Yong Seuk Lee, Young Dong Song, Chong Bum Chang, Seung Baik Kang, Yun Seong Choi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2016

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Abstract

Introduction

The purpose of this study was to conduct a systematic review to address the stability outcome from reconstruction and conservative treatments.

Materials and methods

Inclusion criteria were as follows: (1) English language, (2) human subject, (3) measures of stability outcomes, and (4) patients with isolated PCL injuries. We did not limit the type of study design (interventional or non-interventional study) and included all published systematic reviews. The following data were extracted: the number of study populations, year of publication, baseline characteristics of patients, follow-up period, and outcome data. The primary outcome variable was side-to-side difference (STSD).

Results

In the conservative treatment, the average STSD ranged from 3.5 to 5.3 mm on Telos™ (range 0.7–12.0 mm) and from 3.0 to 5.2 mm on KT-1000™ (range 0.5–10 mm). Among reconstructive treatment, the average STSD ranged from 2.0 to 3.7 mm on Telos™ (range 0–7 mm) and 0.7–5.9 mm on KT-1000™ (range −1 to 11.8 mm). In the conservative treatment, the estimated weighted mean STSD difference was 3.49 [95 % confidence interval (CI): 0.95–6.03] on Telos™ and 2.64 (95 % CI 0.76–4.51) on KT-1000™. On the other hand, in the reconstructive treatment, the estimated mean STSD difference was 8.09 (95 % CI 7.11–9.07) on Telos™ and 8.45 (95 % CI 6.44–10.47) on KT-1000™.

Conclusions

This systematic review noted more satisfactory and consistent stability in the reconstructive treatment group. However, more complications and small differences of stability between groups should be also considered.
Literature
1.
go back to reference Adachi N, Ochi M, Sumen Y, Deie M, Murakami Y, Uchio Y (2003) Temporal changes in posterior laxity after isolated posterior cruciate ligament injury: 35 patients examined by stress radiography and MRI. Acta Orthop Scand 74:683–688CrossRefPubMed Adachi N, Ochi M, Sumen Y, Deie M, Murakami Y, Uchio Y (2003) Temporal changes in posterior laxity after isolated posterior cruciate ligament injury: 35 patients examined by stress radiography and MRI. Acta Orthop Scand 74:683–688CrossRefPubMed
2.
go back to reference Adachi N, Ochi M, Uchio Y, Iwasa J, Ishikawa M, Shinomiya R (2007) Temporal change of joint position sense after posterior cruciate ligament reconstruction using multi-stranded hamstring tendons. Knee Surg Sports Traumatol Arthrosc 15:2–8CrossRefPubMed Adachi N, Ochi M, Uchio Y, Iwasa J, Ishikawa M, Shinomiya R (2007) Temporal change of joint position sense after posterior cruciate ligament reconstruction using multi-stranded hamstring tendons. Knee Surg Sports Traumatol Arthrosc 15:2–8CrossRefPubMed
3.
go back to reference Ahn JH, Chung YS, Oh I (2003) Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 19:101–107CrossRefPubMed Ahn JH, Chung YS, Oh I (2003) Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 19:101–107CrossRefPubMed
4.
go back to reference Ahn JH, Lee SH, Choi SH, Wang JH, Jang SW (2011) Evaluation of clinical and magnetic resonance imaging results after treatment with casting and bracing for the acutely injured posterior cruciate ligament. Arthroscopy 27:1679–1687CrossRefPubMed Ahn JH, Lee SH, Choi SH, Wang JH, Jang SW (2011) Evaluation of clinical and magnetic resonance imaging results after treatment with casting and bracing for the acutely injured posterior cruciate ligament. Arthroscopy 27:1679–1687CrossRefPubMed
5.
go back to reference Ahn JH, Lee YS, Choi SH, Chang MJ, Lee do K (2013) Single-bundle transtibial posterior cruciate ligament reconstruction using a bioabsorbable cross-pin tibial back side fixation. Knee Surg Sports Traumatol Arthrosc 21:1023–1028CrossRefPubMed Ahn JH, Lee YS, Choi SH, Chang MJ, Lee do K (2013) Single-bundle transtibial posterior cruciate ligament reconstruction using a bioabsorbable cross-pin tibial back side fixation. Knee Surg Sports Traumatol Arthrosc 21:1023–1028CrossRefPubMed
6.
go back to reference Boynton MD, Tietjens BR (1996) Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med 24:306–310CrossRefPubMed Boynton MD, Tietjens BR (1996) Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med 24:306–310CrossRefPubMed
7.
go back to reference Chan YS, Yang SC, Chang CH, Chen AC, Yuan LJ, Hsu KY, Wang CJ (2006) Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up. Arthroscopy 22:762–770CrossRefPubMed Chan YS, Yang SC, Chang CH, Chen AC, Yuan LJ, Hsu KY, Wang CJ (2006) Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up. Arthroscopy 22:762–770CrossRefPubMed
8.
go back to reference Chen B, Gao S (2009) Double-bundle posterior cruciate ligament reconstruction using a non-hardware suspension fixation technique and 8 strands of autogenous hamstring tendons. Arthroscopy 25:777–782CrossRefPubMed Chen B, Gao S (2009) Double-bundle posterior cruciate ligament reconstruction using a non-hardware suspension fixation technique and 8 strands of autogenous hamstring tendons. Arthroscopy 25:777–782CrossRefPubMed
9.
go back to reference Chen CH, Chen WJ, Shih CH (2002) Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 18:603–612CrossRefPubMed Chen CH, Chen WJ, Shih CH (2002) Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 18:603–612CrossRefPubMed
10.
go back to reference Fanelli GC (2008) Posterior cruciate ligament rehabilitation: how slow should we go? Arthroscopy 24:234–235CrossRefPubMed Fanelli GC (2008) Posterior cruciate ligament rehabilitation: how slow should we go? Arthroscopy 24:234–235CrossRefPubMed
11.
go back to reference Jung YB, Jung HJ, Song KS, Kim JY, Lee HJ, Lee JS (2010) Remnant posterior cruciate ligament-augmenting stent procedure for injuries in the acute or subacute stage. Arthroscopy 26:223–229CrossRefPubMed Jung YB, Jung HJ, Song KS, Kim JY, Lee HJ, Lee JS (2010) Remnant posterior cruciate ligament-augmenting stent procedure for injuries in the acute or subacute stage. Arthroscopy 26:223–229CrossRefPubMed
12.
go back to reference Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL (2006) Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy 22:329–338CrossRefPubMed Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL (2006) Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy 22:329–338CrossRefPubMed
13.
go back to reference Jung YB, Tae SK, Jung HJ, Lee KH (2004) Replacement of the torn posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method. J Bone Joint Surg Am 86-A:1878–1883PubMed Jung YB, Tae SK, Jung HJ, Lee KH (2004) Replacement of the torn posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method. J Bone Joint Surg Am 86-A:1878–1883PubMed
14.
go back to reference Jung YB, Tae SK, Lee YS, Jung HJ, Nam CH, Park SJ (2008) Active non-operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization. Knee Surg Sports Traumatol Arthrosc 16:729–733CrossRefPubMed Jung YB, Tae SK, Lee YS, Jung HJ, Nam CH, Park SJ (2008) Active non-operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization. Knee Surg Sports Traumatol Arthrosc 16:729–733CrossRefPubMed
15.
go back to reference Kim YM, Lee CA, Matava MJ (2011) Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 39:425–434CrossRefPubMed Kim YM, Lee CA, Matava MJ (2011) Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 39:425–434CrossRefPubMed
16.
go back to reference Lee DY, Kim DH, Park JS, Nam DC, Cho SH, Jeong JH, Hwang SC (2014) Systematic review of cadaveric studies on anatomic posterior cruciate ligament reconstruction: the landmarks in anatomic posterior cruciate ligament reconstruction. Knee Surg Relat Res 26:191–198CrossRefPubMedPubMedCentral Lee DY, Kim DH, Park JS, Nam DC, Cho SH, Jeong JH, Hwang SC (2014) Systematic review of cadaveric studies on anatomic posterior cruciate ligament reconstruction: the landmarks in anatomic posterior cruciate ligament reconstruction. Knee Surg Relat Res 26:191–198CrossRefPubMedPubMedCentral
17.
go back to reference Lee SH, Jung YB, Lee HJ, Jung HJ, Kim SH (2013) Remnant preservation is helpful to obtain good clinical results in posterior cruciate ligament reconstruction: comparison of clinical results of three techniques. Clin Orthop Surg 5:278–286CrossRefPubMedPubMedCentral Lee SH, Jung YB, Lee HJ, Jung HJ, Kim SH (2013) Remnant preservation is helpful to obtain good clinical results in posterior cruciate ligament reconstruction: comparison of clinical results of three techniques. Clin Orthop Surg 5:278–286CrossRefPubMedPubMedCentral
18.
go back to reference Lee YS, Ahn JH, Jung YB, Wang JH, Yoo JC, Jung HJ, Kang BJ (2007) Transtibial double bundle posterior cruciate ligament reconstruction using TransFix tibial fixation. Knee Surg Sports Traumatol Arthrosc 15:973–977CrossRefPubMed Lee YS, Ahn JH, Jung YB, Wang JH, Yoo JC, Jung HJ, Kang BJ (2007) Transtibial double bundle posterior cruciate ligament reconstruction using TransFix tibial fixation. Knee Surg Sports Traumatol Arthrosc 15:973–977CrossRefPubMed
19.
go back to reference Lee YS, Wang JH, Bae JH, Lim HC, Park JH, Ahn JH, Bae TS, Lim BH (2009) Biomechanical evaluation of cross-pin versus interference screw tibial fixation using a soft-tissue graft during transtibial posterior cruciate ligament reconstruction. Arthroscopy 25:989–995CrossRefPubMed Lee YS, Wang JH, Bae JH, Lim HC, Park JH, Ahn JH, Bae TS, Lim BH (2009) Biomechanical evaluation of cross-pin versus interference screw tibial fixation using a soft-tissue graft during transtibial posterior cruciate ligament reconstruction. Arthroscopy 25:989–995CrossRefPubMed
20.
go back to reference Lien OA, Aas EJ, Johansen S, Ludvigsen TC, Figved W, Engebretsen L (2010) Clinical outcome after reconstruction for isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 18:1568–1572CrossRefPubMed Lien OA, Aas EJ, Johansen S, Ludvigsen TC, Figved W, Engebretsen L (2010) Clinical outcome after reconstruction for isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 18:1568–1572CrossRefPubMed
21.
go back to reference Lin YC, Chen SK, Liu TH, Cheng YM, Chou PP (2013) Arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction using patellar tendon graft compared with hamstring tendon graft. Arch Orthop Trauma Surg 133:523–530CrossRefPubMed Lin YC, Chen SK, Liu TH, Cheng YM, Chou PP (2013) Arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction using patellar tendon graft compared with hamstring tendon graft. Arch Orthop Trauma Surg 133:523–530CrossRefPubMed
22.
go back to reference MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22:320–328CrossRefPubMed MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22:320–328CrossRefPubMed
23.
go back to reference Mariani PP, Adriani E, Santori N, Maresca G (1997) Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft. Knee Surg Sports Traumatol Arthrosc 5:239–244CrossRefPubMed Mariani PP, Adriani E, Santori N, Maresca G (1997) Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft. Knee Surg Sports Traumatol Arthrosc 5:239–244CrossRefPubMed
24.
go back to reference Min BH, Lee YS, Lee YS, Jin CZ, Son KH (2011) Evaluation of transtibial double-bundle posterior cruciate ligament reconstruction using a single-sling method with a tibialis anterior allograft. Am J Sports Med 39:374–379CrossRefPubMed Min BH, Lee YS, Lee YS, Jin CZ, Son KH (2011) Evaluation of transtibial double-bundle posterior cruciate ligament reconstruction using a single-sling method with a tibialis anterior allograft. Am J Sports Med 39:374–379CrossRefPubMed
25.
go back to reference Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR (2003) The effect of femoral tunnel position on graft forces during inlay posterior cruciate ligament reconstruction. Am J Sports Med 31:667–672PubMed Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR (2003) The effect of femoral tunnel position on graft forces during inlay posterior cruciate ligament reconstruction. Am J Sports Med 31:667–672PubMed
26.
go back to reference Parolie JM, Bergfeld JA (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38CrossRefPubMed Parolie JM, Bergfeld JA (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38CrossRefPubMed
27.
go back to reference Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD (2005) Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy 21:1042–1050CrossRefPubMed Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD (2005) Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy 21:1042–1050CrossRefPubMed
28.
go back to reference Seon JK, Song EK (2006) Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 22:27–32CrossRefPubMed Seon JK, Song EK (2006) Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 22:27–32CrossRefPubMed
29.
go back to reference Shelbourne KD, Rubinstein RA Jr (1994) Methodist Sports Medicine Center’s experience with acute and chronic isolated posterior cruciate ligament injuries. Clin Sports Med 13:531–543PubMed Shelbourne KD, Rubinstein RA Jr (1994) Methodist Sports Medicine Center’s experience with acute and chronic isolated posterior cruciate ligament injuries. Clin Sports Med 13:531–543PubMed
30.
go back to reference Shino K, Horibe S, Nakata K, Maeda A, Hamada M, Nakamura N (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br 77:895–900PubMed Shino K, Horibe S, Nakata K, Maeda A, Hamada M, Nakamura N (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br 77:895–900PubMed
31.
go back to reference Shon OJ, Lee DC, Park CH, Kim WH, Jung KA (2010) A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2:76–84CrossRefPubMedPubMedCentral Shon OJ, Lee DC, Park CH, Kim WH, Jung KA (2010) A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2:76–84CrossRefPubMedPubMedCentral
32.
go back to reference Spiridonov SI, Slinkard NJ, LaPrade RF (2011) Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J Bone Joint Surg Am 93:1773–1780CrossRefPubMed Spiridonov SI, Slinkard NJ, LaPrade RF (2011) Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J Bone Joint Surg Am 93:1773–1780CrossRefPubMed
33.
go back to reference Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL (2011) Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 40:222–231CrossRefPubMed Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL (2011) Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 40:222–231CrossRefPubMed
34.
go back to reference Wang CJ, Chan YS, Weng LH, Yuan LJ, Chen HS (2004) Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury 35:1279–1285CrossRefPubMed Wang CJ, Chan YS, Weng LH, Yuan LJ, Chen HS (2004) Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury 35:1279–1285CrossRefPubMed
35.
go back to reference Watsend AM, Osestad TM, Jakobsen RB, Engebretsen L (2009) Clinical studies on posterior cruciate ligament tears have weak design. Knee Surg Sports Traumatol Arthrosc 17:140–149CrossRefPubMed Watsend AM, Osestad TM, Jakobsen RB, Engebretsen L (2009) Clinical studies on posterior cruciate ligament tears have weak design. Knee Surg Sports Traumatol Arthrosc 17:140–149CrossRefPubMed
36.
go back to reference Wong T, Wang CJ, Weng LH, Hsu SL, Chou WY, Chen JM, Chan YS (2009) Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach. Arch Orthop Trauma Surg 129:315–321CrossRefPubMed Wong T, Wang CJ, Weng LH, Hsu SL, Chou WY, Chen JM, Chan YS (2009) Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach. Arch Orthop Trauma Surg 129:315–321CrossRefPubMed
37.
go back to reference Wu CH, Chen AC, Yuan LJ, Chang CH, Chan YS, Hsu KY, Wang CJ, Chen WJ (2007) Arthroscopic reconstruction of the posterior cruciate ligament by using a quadriceps tendon autograft: a minimum 5-year follow-up. Arthroscopy 23:420–427CrossRefPubMed Wu CH, Chen AC, Yuan LJ, Chang CH, Chan YS, Hsu KY, Wang CJ, Chen WJ (2007) Arthroscopic reconstruction of the posterior cruciate ligament by using a quadriceps tendon autograft: a minimum 5-year follow-up. Arthroscopy 23:420–427CrossRefPubMed
38.
go back to reference Yoon KH, Bae DK, Song SJ, Cho HJ, Lee JH (2011) A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med 39:474–480CrossRefPubMed Yoon KH, Bae DK, Song SJ, Cho HJ, Lee JH (2011) A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med 39:474–480CrossRefPubMed
39.
go back to reference Yoon KH, Park SW, Lee SH, Kim MH, Park SY, Oh H (2013) Does cast immobilization contribute to posterior stability after posterior cruciate ligament reconstruction? Arthroscopy 29:500–506CrossRefPubMed Yoon KH, Park SW, Lee SH, Kim MH, Park SY, Oh H (2013) Does cast immobilization contribute to posterior stability after posterior cruciate ligament reconstruction? Arthroscopy 29:500–506CrossRefPubMed
40.
go back to reference Zhao J, Huangfu X (2007) Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of 4- versus 7-strand hamstring tendon graft. Knee 14:301–305CrossRefPubMed Zhao J, Huangfu X (2007) Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of 4- versus 7-strand hamstring tendon graft. Knee 14:301–305CrossRefPubMed
41.
go back to reference Zhao J, Xiaoqiao H, He Y, Yang X, Liu C, Lu Z (2008) Sandwich-style posterior cruciate ligament reconstruction. Arthroscopy 24:650–659CrossRefPubMed Zhao J, Xiaoqiao H, He Y, Yang X, Liu C, Lu Z (2008) Sandwich-style posterior cruciate ligament reconstruction. Arthroscopy 24:650–659CrossRefPubMed
Metadata
Title
Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries?
Authors
Soyeon Ahn
Yong Seuk Lee
Young Dong Song
Chong Bum Chang
Seung Baik Kang
Yun Seong Choi
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 6/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2454-4

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