title: Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up.
abstract: OBJECTIVE
  This study presents the 2- to 10-year (24 to 120 month) results of 41 chronic arthroscopically assisted combined posterior cruciate ligament (PCL)-posterolateral reconstructions evaluated preoperatively and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT-1000 arthrometer testing, stress radiography, and physical examination.
  
  
  METHODS
  Case series.
  
  
  METHODS
  This study population included 31 men and 10 women with 24 left and 17 right chronic PCL-posterolateral knee injuries with functional instability. The knees were assessed before and after surgery with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. PCL reconstructions were performed using the arthroscopically assisted single femoral tunnel-single bundle transtibial tunnel PCL reconstruction technique using fresh-frozen Achilles tendon allografts in all 41 cases. In all 41 cases, posterolateral instability reconstruction was performed with combined biceps femoris tendon tenodesis, and posterolateral capsular shift procedures.
  
  
  RESULTS
  Postoperative physical examination revealed normal posterior drawer and tibial stepoff in 29 of 41 (70%) knees. Posterolateral stability was restored to normal in 11 of 41 (27%) knees, and tighter than normal knee was found in 29 of 41(71%) knees evaluated with the external rotation thigh foot angle test. A 30 degrees varus stress testing was normal in 40 of 41 (97%) knees, and grade 1 laxity in 1 of 41 (3%) knees. Postoperative KT-1000 arthrometer testing mean side to side difference measurements were 1.80 mm (PCL screen) and 2.11 mm (corrected posterior; P =.001). The postoperative stress radiographic mean side-to-side difference measurement measured at 90 degrees of knee flexion and 32 lb of posterior directed force applied to the proximal tibia using the Telos device was 2.26 mm (P =.001). Postoperative Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scale mean values were 91.7, 4.92, and 88.7, respectively (P =.001). All objective parameters showed a statistically significant improvement from preoperative status.
  
  
  CONCLUSIONS
  Chronic combined PCL-posterolateral instabilities can be successfully treated with arthroscopic PCL reconstruction using fresh-frozen Achilles tendon allograft combined with posterolateral corner reconstruction using biceps tendon tenodesis combined with posterolateral capsular shift procedure. Statistically significant improvement is noted (P =.001) from the preoperative condition at 2 to 10 years' follow-up evaluation using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination.
  
  
  METHODS
  Level IV, case series (no historical or control group).
authors.affiliation: Fanelli Sports Injury Clinic, Department Of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA. gfanelli@geisinger.edu
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Fanelli
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Edson
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods* / Q000706:statistics & numerical data; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007718:Knee Injuries / Q000534:rehabilitation; D008297:Male; D016119:Posterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D020127:Recovery of Function; D013710:Tendons / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome