title: Reconstruction of the posterior oblique ligament and the posterior cruciate ligament in knees with posteromedial instability.
abstract: OBJECTIVE
  Posterior cruciate ligament (PCL) injuries are often associated with injuries of the posteromedial structures of the knee. The motivation for this study was the attempt to test different reconstruction techniques for the structures of the posteromedial corner in a biomechanical experiment.
  
  
  METHODS
  Kinematic studies were carried out on 10 cadaveric knees exposed to a 134-N posterior tibial load, 10-Nm valgus torque, and 5-Nm internal torque at 0°, 30°, 60°, and 90° of flexion. The resulting posterior tibial translation (PTT) was determined using a robotic/universal force-moment sensor testing system for (1) intact knees, (2) PCL-deficient knees, (3) knees with deficiency of the PCL and the posteromedial structures, (4) knees with only the PCL reconstructed, (5) knees with the PCL and posterior oblique ligament (POL) reconstructed, and (6) knees with the PCL, medial collateral ligament (MCL), and POL reconstructed. Kinematic data were analyzed by a 2-factor repeated analysis of variance.
  
  
  RESULTS
  When both the PCL and the posteromedial structures were cut, PTT increased significantly at all flexion grades under a posterior tibial load (P < .05). Reconstruction of only the PCL could not restore PTT at 0°, 30°, 60°, and 90° of flexion under loading conditions in a knee with combined injury of the PCL and the posteromedial structures (P > .05). Additional reconstruction of the POL improved PTT at all flexion angles in comparison with only the PCL-reconstructed knee. Reconstruction of the MCL had no significant effect on PTT.
  
  
  CONCLUSIONS
  This study shows that reconstruction of the POL contributes significantly to the normalization of coupled PTT in knees with combined injury of the PCL and the posteromedial structures under valgus or internal rotational moment. The supplementary reconstruction of the MCL did not provide significant improvement in knee kinematics.
  
  
  CONCLUSIONS
  The POL should be addressed in the patient with combined injuries of the PCL and the posteromedial structures.
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, Westfalian Wilhelms University, Münster, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Weimann
authors.forename: Imke
authors.initials: I
authors.lastname: Schatka
authors.forename: Mirco
authors.initials: M
authors.lastname: Herbort
authors.forename: Andrea
authors.initials: A
authors.lastname: Achtnich
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
authors.forename: Michael
authors.initials: M
authors.lastname: Raschke
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures