Posterior Cruciate Ligament

IntroductionAlthough being debated for many years, the superiority of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. We compare the knee scores, post-operative knee range of motion (ROM), radiological outcomes about knee kinematic and complications between CR TKA and PS TKA.MethodsLiterature published up to August 2015 was searched in PubMed, Embase and Cochrane databases, and meta-analysis was performed using the software, Review Manager version 5.3.ResultsTotally 14 random control trials (RCTs) on this topic were included for the analysis, which showed that PS and CR TKA had no significant difference in Knee Society knee Score (KSS), pain score (KSPS), Hospital for Special Surgery score (HSS), kinematic characteristics including postoperative component alignment, tibial posterior slope and joint line, and complication rate. However, PS TKA is superior to CR TKA regarding post-operative knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -7.07, 95% Confidential Interval (CI) -10.50 to -3.65, pConclusionsThere are no clinically relevant differences between CR and PS TKA in terms of clinical, functional, radiological outcome, and complications, while PS TKA is superior to CR TKA in respects of ROM, while whether this superiority matters or not in clinical practice still needs further investigation and longer follow-up.

ObjectiveTo study the association between Cruciate Ligament (CL) injury and development of post-traumatic osteoarthritis in the knee in patients treated operatively with CL reconstruction compared with patients treated non-operatively.DesignPopulation based cohort study; level of evidence II-2.SettingSweden, 1987-2009.ParticipantsAll patients aged between 15-60 years being diagnosed and registered with a CL injury in The National Swedish Patient Register between 1987 and 2009.Main outcome measuresKnee osteoarthritis.ResultsA total of 64,614 patients diagnosed with CL injury during 1987 to 2009 in Sweden were included in the study. Seven percent of the patients were diagnosed with knee OA in specialized healthcare during the follow-up (mean 9 years). Stratified analysis by follow-up showed that while those with shorter follow-up had a non-significant difference in risk (0.99, 95%CI 0.90-1.09 for follow-up less than five years compared with the non-operated cohort), those with longer follow-up had an increased risk of knee OA after CL reconstruction (HR = 1.42, 95%CI 1.27-1.58 for follow-up more than ten years compared with non-operated cohort). The risk to develop OA was not affected by sex.ConclusionCL reconstructive surgery does not seem to have a protective effect on long term OA in either men or women.

PurposeThe main purpose of the study was to provide an overview of injury mechanisms, concomitant injuries, and other relevant epidemiological data for patients treated in Scandinavia with posterior cruciate ligament reconstruction (PCLR) following a posterior cruciate ligament (PCL) injury.MethodsA total number of 1287 patients who underwent PCLR from 2004 to 2013 in the Scandinavian counties were included from the national ligament registries. The variables such as age, sex, activity, and graft used for reconstruction were collected. Then, injuries were sorted based on concomitant injuries. Finally, data from the different registries were compared.ResultsAverage age of the treated patients was 32.7 years. Sex distribution ratio of male to female was 858:429 (66.7 %:33.3 %). Depending on definition, 26-37 % of the injuries treated were isolated PCL injuries. PCL injuries were most commonly encountered in sports with 35.4 % of the total number of PCL injuries in the study population. Soccer was the sport with the highest number of injuries (13.1 %). Cartilage lesions occurred in 26.1 % of PCL injuries and meniscal lesions in 21.0 %. Minimum one other additional ligament was injured in 62.2 %.ConclusionIsolated PCL injuries are common, although the injury is most commonly associated with other ligament injuries. There is a high prevalence of cartilage injuries and meniscal lesions associated with PCL injuries. Sports are the leading cause of PCL injuries treated operatively. Epidemiological data are a necessary part of the basis for injury prevention in the future. The prevalence of concomitant injuries is also relevant and clinically important for the choice of surgical procedure and for the expected outcomes following surgery.Level of evidenceII.

PurposeThe main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries.MethodsA structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary 'agree/disagree' in the final third round. Levels of evidence were assigned to each statement using standardized A-E and GRADE grading systems based on the available data.ResultsHigh agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%-100%), whereas for 7 agreement was ConclusionBy providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes.Study designExpert survey.Level of evidenceLevel V.