Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techn
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Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation Philipp W. Winkler1,2 · Bálint Zsidai3 · Nyaluma N. Wagala2 · Jonathan D. Hughes2 · Alexandra Horvath4 · Eric Hamrin Senorski5 · Kristian Samuelsson3,6 · Volker Musahl2 Received: 16 September 2020 / Accepted: 13 October 2020 © The Author(s) 2020
Abstract Isolated and combined posterior cruciate ligament (PCL) injuries are associated with severe limitations in daily, professional, and sports activities as well as with devastating long-term effects for the knee joint. As the number of primary and recurrent PCL injuries increases, so does the body of literature, with high-quality evidence evolving in recent years. However, the debate about the ideal treatment approach such as; operative vs. non-operative; single-bundle vs. double-bundle reconstruction; transtibial vs. tibial inlay technique, continues. Ultimately, the goal in the treatment of PCL injuries is restoring native knee kinematics and preventing residual posterior and combined rotatory knee laxity through an individualized approach. Certain demographic, anatomical, and surgical risk factors for failures in operative treatment have been identified. Failures after PCL reconstruction are increasing, confronting the treating surgeon with challenges including the need for revision PCL reconstruction. Part 2 of the evidence-based update on the management of primary and recurrent PCL injuries will summarize the outcomes of operative and non-operative treatment including indications, surgical techniques, complications, and risk factors for recurrent PCL deficiency. This paper aims to support surgeons in decision-making for the treatment of PCL injuries by systematically evaluating underlying risk factors, thus preventing postoperative complications and recurrent knee laxity. Level of evidence V. Keywords Posterior cruciate ligament · PCL · Revision · Failure · Knee · Single-bundle · Double-bundle · Risk factors · Transtibial · Tibial inlay * Philipp W. Winkler [email protected] 1
Department for Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
2
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA 15203, USA
3
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
4
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
5
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
6
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Abbreviations ACL Anterior cruciate ligament ALB Anterolateral bundle AP Anterior–posterior DB Double-bundle IKD
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