title: Arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers: clinical results of minimum 2-year follow-up.
abstract: BACKGROUND
  The transtibial technique for posterior cruciate ligament reconstructions can potentially lead to poor clinical outcomes due to the "killer turn" effect.
  
  
  OBJECTIVE
  Preserving the original posterior cruciate ligament fibers in the reconstruction will contribute significantly to the posterior stability of the knee joint, healing of the graft, and prevention of graft failure.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Sixty-one patients (45 men and 16 women; mean age, 30.4 years) underwent transtibial posterior cruciate ligament reconstruction with preservation of the cruciate ligament fibers; they were reviewed at a mean period of 40.8 months. All patients were assessed with the Lysholm knee score, International Knee Documentation Committee subjective and objective evaluations, and KT-2000 arthrometry. Follow-up magnetic resonance imaging was performed in 40 patients; images were assessed for graft continuity, thickness, and signal intensity. Second-look arthroscopy was performed in 42 patients.
  
  
  RESULTS
  The mean Lysholm score improved from 65.8 to 92.9. The final International Knee Documentation Committee subjective evaluation rated all patients as normal or nearly normal, and the objective evaluation showed normal or nearly normal in 59 patients (97%) and abnormal in 2 patients (3%). The mean side-to-side difference on the KT-2000 arthrometer was 2.79 mm. All patients showed well-preserved graft continuity on magnetic resonance images. Mean graft thickness was 9.9 mm in the sagittal plane and 12.3 mm in the coronal oblique plane. Images for all patients revealed homogeneously low signal intensity in the distal portion of the graft, with complete healing of the graft and original posterior cruciate ligament fibers as one ligament. Graft loosening or graft tear by the killer turn effect was not detected in any patients. Second-look arthroscopy revealed complete healing and graft integration, with the original posterior cruciate ligament fibers in all patients.
  
  
  CONCLUSIONS
  In transtibial posterior cruciate ligament reconstructions, poor outcomes from the killer turn effect may be reduced by preserving the original posterior cruciate ligament fibers.
authors.affiliation: Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Kangnam-Ku, Seoul, Korea. jha@smc.samsung.co.kr
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Hyoung Seop
authors.initials: HS
authors.lastname: Yang
authors.forename: Woong Kyo
authors.initials: WK
authors.lastname: Jeong
authors.forename: Kyoung Hwan
authors.initials: KH
authors.lastname: Koh
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation; D000328:Adult; D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome