title: Non-hardware posterior cruciate ligament reconstruction using knot/press-fit technique with periosteum-enveloped hamstrings tendon autograft.
abstract: BACKGROUND
  Several posterior cruciate ligament reconstruction procedures have been proposed to manage ruptures.
  
  
  OBJECTIVE
  This study was intended to present the clinical results of non-hardware reconstruction of posterior cruciate ligament using a knot/press-fit technique with periosteum-enveloped autogenous hamstring tendons.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This arthroscopically assisted technique was used in 33 patients with posterior cruciate ligament ruptures. In this non-hardware technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. Each loop was enveloped in periosteum. After passing a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (knotted grafts lodging in the bottleneck of the femoral tunnel). Simultaneously, the intra-articular opening of the tibial tunnel was filled with the periosteum-enveloped portion of the graft. A tie with Mersilene tape over a bone bridge for each tendon loop was used for tibial fixation.
  
  
  RESULTS
  The average follow-up was 35 months (range, 24-60 months). Clinical assessments included Tegner score, Lysholm knee score, International Knee Documentation Committee scores, thigh muscle assessment, and radiographic evaluation. The stress radiography results for posterior displacement changed from 13.7 ± 2.1 mm preoperatively to 4.8 ± 1.1 mm postoperatively. Average preinjury Tegner score was 5.9 (range, 3-9), decreasing to 2.9 (range, 2-5) preoperatively and increasing to 5.2 (range, 2-9) postoperatively. The Lysholm score increased from 58.5 ± 5.2 to 94.2 ± 4.1 (P < .01). Finally, 26 patients (89.7%) were assessed as nearly normal by International Knee Documentation Committee guidelines.
  
  
  CONCLUSIONS
  The study revealed satisfactory clinical subjective and objective results at a minimum of 2 years' follow-up. Without using hardware, this alternative technique has the advantage of no need for removal of hardware and potentially easier magnetic resonance imaging interpretation and revision surgery.
authors.affiliation: Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. ctycgmh@gmail.com
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chuang
authors.forename: Wei-Pin
authors.initials: WP
authors.lastname: Ho
authors.forename: Chih-Hwa
authors.initials: CH
authors.lastname: Chen
authors.forename: Ming-Hsin
authors.initials: MH
authors.lastname: Shieh
authors.forename: Jiann-Jong
authors.initials: JJ
authors.lastname: Liau
authors.forename: Chang-Hung
authors.initials: CH
authors.lastname: Huang
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery*; D008875:Middle Aged; D009133:Muscular Atrophy / Q000175:diagnosis; D016119:Posterior Cruciate Ligament / Q000293:injuries*; D011183:Postoperative Complications / Q000175:diagnosis*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D055815:Young Adult