Steadman Philippon Research Institute, Vail, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2018 Jul;46(8):1809-1818. doi: 10.1177/0363546517750855.
Historically, outcomes of posterior cruciate ligament (PCL) reconstructions have been less predictable and reported to yield inferior results when compared with those for anterior cruciate ligament (ACL) reconstructions.
To report on the outcomes of double-bundle PCL reconstructions (DB PCLRs) in isolated versus combined injuries and acute versus chronic PCL reconstructions. To compare the outcomes of isolated DB PCLR with isolated ACL reconstruction.
Cohort study; Level of evidence, 3.
All patients who underwent a primary endoscopic DB PCLR for complete PCL tears (grade III) between May 2010 and March 2015 were reviewed. Patient-reported outcome scores (Tegner, Lysholm, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index], SF-12 [12-item Short Form Health Survey]) and objective posterior stress radiographs were collected preoperatively and at a minimum 2 years postoperatively. A cohort subanalysis was additionally performed between isolated and combined PCL reconstruction and acute versus chronic PCL reconstruction. Patients who underwent isolated ACL reconstructions over the same inclusion period (2010-2015) were selected as a comparison group.
One hundred patients who underwent DB PCLR were included in this study. There were 31 isolated PCL injuries, and 69 patients had concurrent combined PCL injuries requiring surgery. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). The median Tegner activity score improved from 2 to 5, Lysholm from 48 to 86, WOMAC from 35.5 to 5, and SF-12 Physical Component Summary from 34 to 54.8 (all P values <.001). The mean side-to-side difference in posterior tibial translation on kneeling stress radiographs improved from 11.0 ± 3.5 mm preoperatively to 1.6 ± 2.0 mm postoperatively ( P < .001). There were no differences in postoperative functional scores between isolated PCL reconstructions and PCL-based multiligament reconstructions (all P values >.229). There was no significant difference in the reported outcome scores between acute and chronic reconstructions (all P values >.087) except for Tegner scores ( P < .001) and patient satisfaction ( P = .011) favoring acutely treated PCL injuries. There were no significant differences between patients who had an isolated DB PCLR and patients who underwent an isolated ACL reconstruction (n = 141) in postoperative outcome scores (all P values >.064).
Significantly improved functional and objective outcomes were observed after anatomic DB PCLR at a mean 3 years' follow-up, with low complication rates, regardless of concomitant ligamentous injury or timing to surgery. Additionally, contrary to previous reports, comparable subjective and functional clinical outcomes were achieved compared with an isolated ACL reconstruction control cohort.
历史上，与前交叉韧带（ACL）重建相比，后交叉韧带（PCL）重建的结果更不可预测，报告的结果也更差。
报告在单纯损伤与联合损伤、急性与慢性 PCL 重建中，双束 PCL 重建（DB PCLR）的结果。比较单纯 DB PCLR 与单纯 ACL 重建的结果。
队列研究；证据等级，3 级。
回顾 2010 年 5 月至 2015 年 3 月期间接受原发性内镜下 DB PCLR 治疗完全 PCL 撕裂（III 级）的所有患者。收集术前和至少 2 年后的患者报告的结局评分（Tegner、Lysholm、WOMAC[西部安大略省和麦克马斯特大学骨关节炎指数]、SF-12[12 项简短健康调查]）和客观的后向压力 X 线片。还在单纯和联合 PCL 重建以及急性与慢性 PCL 重建之间进行了队列亚分析。选择在同一纳入期间（2010-2015 年）接受单纯 ACL 重建的患者作为对照组。
本研究共纳入 100 例行 DB PCLR 的患者。其中 31 例为单纯 PCL 损伤，69 例患者合并需要手术的联合 PCL 损伤。PCL 队列的平均随访时间为 2.9 年（范围，2-6 年）。Tegner 活动评分中位数从 2 分提高到 5 分，Lysholm 从 48 分提高到 86 分，WOMAC 从 35.5 分提高到 5 分，SF-12 生理成分评分从 34 分提高到 54.8 分（所有 P 值均<.001）。屈膝压力 X 线片中胫骨后向平移的平均侧间差值从术前 11.0±3.5mm 改善至术后 1.6±2.0mm（P<.001）。单纯 PCL 重建与 PCL 为主的多韧带重建之间的术后功能评分无差异（所有 P 值均>.229）。急性和慢性重建之间除 Tegner 评分（P<.001）和患者满意度（P=.011）外，报告的结局评分无显著差异（P>.087），前者更有利于急性 PCL 损伤。行单纯 DB PCLR 的患者与行单纯 ACL 重建的患者（n=141）的术后结局评分无显著差异（所有 P 值均>.064）。
在平均 3 年的随访中，行解剖学 DB PCLR 后可获得明显改善的功能和客观结局，且并发症发生率较低，与合并韧带损伤或手术时机无关。此外，与之前的报告相反，与单纯 ACL 重建对照组相比，可获得相似的主观和功能临床结局。
