Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach.
BACKGROUND
The hypothesis of this study is that anterolateral (A-L) trans-tibia approach is better than anteromedial (A-M) technique in posterior cruciate ligament (PCL) reconstruction. The purpose of this prospective clinical study was to compare the functional outcomes of A-M and A-L trans-tibia approach in arthroscopic PCL reconstruction.


METHODS
Between 1999 and 2003, 55 patients (55 knees) with an average age of 30 +/- 11 years (range 16-60 years) underwent arthroscopic single-bundle reconstruction for symptomatic isolated PCL tear. Patients were randomly divided into two groups with 28 patients (28 knees) undergoing A-M trans-tibia approach on odd-numbered days, and 27 patients (27 knees) with A-L trans-tibia approach on even-numbered days. Hamstring auto grafts were used in all cases. All patients received the same rehabilitation program postoperatively. The evaluation parameters included clinical assessment, functional outcome, ligament laxity and radiographic changes of the affected knee.


RESULTS
Significant improvements in pain and function of the knee were observed at an average follow-up of 48 +/- 15.9 months for A-M and 45.0 +/- 13.7 months for A-L approach. However, the difference between the two techniques was statistically not significant. In IKDC for symptom-activity level, normal or nearly normal knees were noted in 68% of A-M and 67% of A-L approach, respectively, but no difference was noted between the two groups. In ligament laxity, approximately two-thirds of the knees showed normal posterior laxity with no difference between the two groups. Radiographs of the knee showed no discernible difference in the overall alignment and degenerative changes as well as the sizes of bone tunnel between the two groups.


CONCLUSIONS
A-M and A-L trans-tibia arthroscopic PCL reconstructions produced comparable clinical results in short-term follow-up. Contrary to our initial hypothesis, the theoretical disadvantages of A-M technique including graft failure were not observed during the follow-up period. Long-term results are needed to confirm the adverse effects of A-M trans-tibia approach in PCL reconstruction.
Wong
To
T
Department of Orthopedics and Sports Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung Hsiang, Kaohsiung, Taiwan.
Wang
Ching-Jen
CJ
Weng
Lin-Hsiu
LH
Hsu
Shan-Ling
SL
Chou
Wen-Yi
WY
Chen
June-Ming
JM
Chan
Yi-Sheng
YS
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult