Comparable clinical and radiological outcomes between anatomical and high femoral tunnels in posterior cruciate ligament
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Comparable clinical and radiological outcomes between anatomical and high femoral tunnels in posterior cruciate ligament reconstruction Kyoung Ho Yoon1 · Jung‑Suk Kim1 · Jae‑Young Park1 · Soo Yeon Park2 · Raymond Yeak Dieu Kiat3 · Sang‑Gyun Kim4 Received: 22 March 2020 / Accepted: 31 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To compare clinical and radiological outcomes and failure rates between anatomical and high femoral tunnels in remnant-preserving single-bundle posterior cruciate ligament (PCL) reconstruction. Methods 63 patients who underwent remnant-preserving single-bundle PCL reconstruction between 2011 and 2018 with a minimum 2-year follow-up were retrospectively reviewed. Patients were divided into two groups according to the femoral tunnel position: group A (33 patients with anatomical femoral tunnel) and group H (30 patients with high femoral tunnels). The femoral tunnel was positioned at the center (group A) or upper margin (group H) of the remnant anterolateral bundle. The position of the femoral tunnel was evaluated using the grid method on three-dimensional computed tomography. Clinical and radiological outcomes and failure rates were compared between the groups at the 2-year follow-up. Results The position of the femoral tunnel was significantly high in group H than in group A (87.4% ± 4.2% versus 76.1% ± 3.7%, p 10 mm] or grade II instability (STSD 5–10 mm), with discomfort after at least 6 weeks of non-operative treatment during the acute stage. The exclusion criteria were: (1) revision PCL reconstruction, (2) DB PCL reconstruction, (3) bilateral PCL injury, (4) concomitant ipsilateral fracture around the knee, (5) insufficient computed tomography (CT) data, (6) multi-ligament injury requiring combined ligament surgery, and (7) follow-up less than 2 years. Finally, 63 patients were enrolled in this study (Fig. 1). The preoperative demographic data of enrolled patients are summarized in Table 1. Until January 2015, high femoral tunnels with remnant preservation were used for all patients who underwent primary SB PCL reconstruction. Thereafter, the target point of the femoral tunnel was changed to the anatomical position. Arthroscopic pictures and operation records were retrospectively reviewed to confirm the position of the femoral tunnel. Based on the femoral tunnel position, patients were divided into two groups: group A (33 patients with anatomical femoral tunnel) and group H (30 patients with high femoral tunnels).
Surgical technique All arthroscopic procedures for PCL reconstruction were performed by a single experienced surgeon using the same surgical technique except the placement of the femoral tunnel. A fresh-frozen Achilles allograft was used in all cases. The bony portion for the tibial tunnel was designed to be
Materials and methods After obtaining institutional review board approval (ID: KHUH 2020-02-020, Kyung Hee University Hospital), data of patients who underwent PCL reconstruction
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Fig. 1 Flo
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