title: Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results.
abstract: OBJECTIVE
  Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot.
  
  
  METHODS
  Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale.
  
  
  RESULTS
  The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in the healthy knee and 65 % in group A and 64.9 % in group B in the operated knee (angular velocity 180°/s). Lysholm outcome was 93.9 ± 3.9 in group A and 89.1 ± 7.6 in group B (n.s). Cincinnati score was 89.6 ± 7.3 in group A and 91.0 ± 6.9 in group B (p = 0.791). IKDC results were group A in six patients (60 %), group B in three patients (30 %) and group C in one patient (10 %) in the allograft group and group A in seven patients (70 %) and group B in three patients (30 %) for autologous group.
  
  
  CONCLUSIONS
  The results of this study suggest that one-stage arthroscopic bicruciate ligament reconstruction can restore good knee joint function. Surgical treatment should be followed by a comprehensive rehabilitation programme with specific goals, objectives and strategies, including pain management and assessment of progress in recovery of joint function and perception of knee stability.
  
  
  METHODS
  Retrospective case series, Level IV.
authors: Knee Surgery and Sports Traumatology Unit, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
authors: Matteo
authors: M
authors: Denti
authors: Center for Sports Rehabilitation, IRCCS Galeazzi Orthopedics Institute, Milan, Italy.
authors: Davide
authors: D
authors: Tornese
authors: Rehabilitation I Unit, IRCCS Galeazzi Orthopedics Institute, Milan, Italy.
authors: Gianluca
authors: G
authors: Melegati
authors: Sports Traumatology and Arthroscopic Surgery Unit, IRCCS Galeazzi Orthopedics Institute, Milan, Italy.
authors: Herbert
authors: H
authors: Schonhuber
authors: Knee Surgery and Sports Traumatology Unit, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy. alequaglia@hotmail.com.
authors: Alessandro
authors: A
authors: Quaglia
authors: Knee Surgery and Sports Traumatology Unit, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
authors: Piero
authors: P
authors: Volpi
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D001182:Arthroscopy; D050376:Bone-Patellar Tendon-Bone Grafting; D006801:Humans; D065466:Lysholm Knee Score; D063868:Patient Outcome Assessment; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*
keywords: Anterior cruciate ligament (ACL); Concentric isokinetic test; Functional outcomes; Knee; Multiligamentous injury; Posterior cruciate ligament (PCL)