title: Second-look arthroscopic assessment of arthroscopic single-bundle posterior cruciate ligament reconstruction: comparison of mixed graft versus achilles tendon allograft.
abstract: BACKGROUND
  Although controversy continues over the choice of graft tissue, including autografts, allografts, and synthetic ligaments, for posterior cruciate ligament (PCL) reconstruction, the use of a mixed graft consisting of a hamstring (semitendinosus and gracilis) autograft plus tibialis anterior allograft tendon has not been studied in detail.
  
  
  OBJECTIVE
  Outcomes of PCL reconstructions performed with a mixed graft would be superior to those using solely an Achilles tendon allograft in terms of functional knee scores, posterior stability, and the graft appearance.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  Fifty-eight patients who underwent isolated single-bundle PCL reconstruction using an arthroscopic trans-septal portal with remnant preservation technique were evaluated. They were divided into group A (mixed tendon; n = 30) and group B (Achilles tendon; n = 28). Knee function was evaluated using the Lysholm knee score, Tegner activity score, and the International Knee Documentation Committee (IKDC) grading scale. Anteroposterior stability was measured using the Telos stress view. Twenty patients (66.7%) from group A and 21 patients (75.0%) from group B underwent hardware removal and a second-look arthroscopic examination.
  
  
  RESULTS
  The Lysholm knee scores in groups A and B increased from a respective average of 43 and 50 preoperatively to 90 and 88 at follow-up. The IKDC grade and Tegner activity scores were also significantly improved in both groups. Stability was improved in both groups, with an average posterior laxity of 3.0 mm (group A) and 3.3 mm (group B) at follow-up (P > .05). However, there were 4 intraoperative complications in group B: 2 bone fractures and 2 graft pullouts during precyclic tensioning. Second-look arthroscopy revealed a partial tear in 8 cases (40%) from group A and 15 cases (71.4%) from group B (P = .03). All of the partial tears were located in the femoral aperture area. Complete synovial coverage was demonstrated in 10 patients (50%) from group A and 5 patients (23.8%) from group B (P = .04). However, clinical outcomes and stability were not affected by the arthroscopic graft appearance.
  
  
  CONCLUSIONS
  Satisfactory results were obtained for groups A and B in patients who underwent reconstruction for isolated PCL injury. However, 4 intraoperative complications (14.3%) were encountered with use of the Achilles tendon allograft (group B), with a relative higher rate of partial tear and less synovialization in the femoral aperture area.
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Jae-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Jung-Ro
authors.initials: JR
authors.lastname: Yoon
authors.forename: Hyeon-Il
authors.initials: HI
authors.lastname: Jeong
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Hwang
authors.forename: Sung-Jong
authors.initials: SJ
authors.lastname: Woo
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Kwon
authors.forename: Kyung-Wook
authors.initials: KW
authors.lastname: Nha
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D024162:Second-Look Surgery; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult