Anatomic repair and ligament bracing as an alternative treatment option for acute combined PCL injuries involving the posteromedial or posterolateral corner-results of a multicentre study.
Augmented suture repair
Combined PCL injury
Ligament bracing
Posterolateral corner
Posteromedial corner
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
22
02
2023
accepted:
24
07
2023
medline:
13
11
2023
pubmed:
11
9
2023
entrez:
10
9
2023
Statut:
ppublish
Résumé
Combined PCL injuries involving the posteromedial/-lateral corner (PMC/PLC) usually require surgical management. Literature shows controversy regarding the standards of treatment. Suture-augmented repair leads to excellent results in acute knee dislocations but has not been investigated clinically in combined PCL injuries. The purpose of this multicentre study was to evaluate the clinical outcome of this technique in acute combined PCL injuries. N = 33 patients with acute combined PCL injuries involving the PMC/PLC were treated by one-stage suture repair with ligament bracing of the PCL and suture repair of the accompanying PMC/PLC injuries with/without ligament bracing or primary augmentation by semitendinosus autograft. Outcome was assessed by IKDC questionnaire, Lysholm Score, Tegner Activity Scale and KOOS. Additional PCL stress-radiography was performed. N = 31 patients with combined PCL injuries (female: male = 7:24; age 39.1 ± 13.8 years) with a follow-up of 16.8 ± 9.6 months were finally evaluated. 18 had PMC injuries, 13 PLC injuries. 32.2% presented with accompanying meniscal tears (70% medial meniscus). 19.4% showed cartilage injuries grade III-IV. Complications included one infection and four knee stiffnesses. Three had symptomatic postoperative instability, all affiliated to the PLC group. The IKDC was 69.8 ± 16.5, Lysholm score 85 ± 14.4 and KOOS 89.7 ± 8.1. Median loss of activity (Tegner) was 0.89 ± 1.31. Comparing PMC and PLC, all scores showed a tendency towards more favourable outcomes in the PMC group (n.s.). Stress-radiography showed an overall side-to-side difference of 3.7 ± 3.8 mm. Subgroup evaluation showed statistically significant better results (p = 0.035) of PMC (2.5 ± 1.5 mm) versus PLC (5.8 ± 5.6 mm). One-stage suture repair with ligament bracing is a viable technique for acute combined PCL injuries and predominantly leads to good and excellent clinical outcomes. Patients with PLC injuries show a tendency towards inferior outcomes and higher instability rates compared to PMC injuries. These results may help in therapy planning and counselling patients with these rare injury pattern. Level II.
Identifiants
pubmed: 37691046
doi: 10.1007/s00402-023-05015-5
pii: 10.1007/s00402-023-05015-5
pmc: PMC10635947
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7123-7132Informations de copyright
© 2023. The Author(s).
Références
Am J Sports Med. 2010 Sep;38(9):1900-6
pubmed: 20522827
Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1017-22
pubmed: 22801932
Cureus. 2021 Jan 3;13(1):e12447
pubmed: 33552765
Knee Surg Sports Traumatol Arthrosc. 2013 Jul;21(7):1502-9
pubmed: 22868350
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2710-2718
pubmed: 30631909
Orthop Surg. 2020 Apr;12(2):692-697
pubmed: 32157830
Acta Orthop. 2007 Aug;78(4):445-53
pubmed: 17965996
Arthroscopy. 2003 Mar;19(3):262-8
pubmed: 12627150
Clin Orthop Relat Res. 2002 May;(398):169-75
pubmed: 11964647
Arthrosc Tech. 2018 Dec 03;8(1):e7-e10
pubmed: 30899644
Cartilage. 2017 Apr;8(2):139-145
pubmed: 28345404
Arthrosc Tech. 2019 Jun 10;8(7):e691-e695
pubmed: 31467838
Can J Surg. 2004 Feb;47(1):20-4
pubmed: 14997920
Unfallchirurg. 2014 Jul;117(7):650-7
pubmed: 24893725
J Exp Orthop. 2021 Apr 15;8(1):28
pubmed: 33860391
Am J Sports Med. 2018 Jul;46(8):1863-1869
pubmed: 29953291
Oper Orthop Traumatol. 2014 Feb;26(1):19-29
pubmed: 24553686
Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1050-63
pubmed: 23377797
Arthrosc Tech. 2017 Sep 25;6(5):e1685-e1690
pubmed: 29399451
Sports Med Arthrosc Rev. 2020 Mar;28(1):23-29
pubmed: 31895329
Arthroscopy. 2007 Oct;23(10):1066-72
pubmed: 17916471
Am J Sports Med. 2011 May;39(5):1102-13
pubmed: 21148144
Am J Sports Med. 2011 Jun;39(6):1332-40
pubmed: 21173192
Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):2976-2986
pubmed: 33104867
Arthrosc Tech. 2019 Jul 30;8(8):e911-e916
pubmed: 31700786
Am J Sports Med. 2005 Jun;33(6):881-8
pubmed: 15827360
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2520-2529
pubmed: 30478468
Orthop Res Rev. 2017 Apr 05;9:13-22
pubmed: 30774473
Am J Sports Med. 2010 Apr;38(4):804-9
pubmed: 20118498
Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):226-34
pubmed: 8536037
Orthopade. 2012 Mar;41(3):206-11
pubmed: 22407095
Clin Orthop Relat Res. 1985 Sep;(198):43-9
pubmed: 4028566
Oper Orthop Traumatol. 2019 Feb;31(1):12-19
pubmed: 30478635
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3673-3681
pubmed: 29691616
Am J Sports Med. 2004 Mar;32(2):346-60
pubmed: 14977658
J Knee Surg. 2021 Apr;34(5):478-485
pubmed: 33472263
Arch Orthop Trauma Surg. 2012 May;132(5):649-54
pubmed: 22203057
Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2543-2550
pubmed: 32047998
Clin Orthop Relat Res. 2012 Mar;470(3):806-14
pubmed: 21909850
Clin Orthop Relat Res. 1991 Jun;(267):103-7
pubmed: 2044260
Arthroscopy. 2012 Sep;28(9):1283-9
pubmed: 22541643
Orthop J Sports Med. 2014 May 16;2(5):2325967114534387
pubmed: 26535332
Am J Sports Med. 2002 Sep-Oct;30(5):718-27
pubmed: 12239009
Arthroscopy. 2005 Sep;21(9):1147
pubmed: 16171645