Glover Mark A, Mason Thomas W, Albertson Benjamin S, Trasolini Nicholas A, Waterman Brian R
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2024 Jan 12;4(1):26350254231184905. doi: 10.1177/26350254231184905. eCollection 2024 Jan-Feb.
Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal.
PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes.
A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises.
At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol.
DISCUSSION/CONCLUSION: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
股四头肌自体移植虽然在重建前交叉韧带方面已得到充分确立，但在重建后交叉韧带（PCL）中应用不足，主要原因是采用速度缓慢。全内半月板斜坡修复术和股四头肌肌腱自体移植PCL重建术已分别有描述，但未在视频期刊中同时呈现。
对于3级孤立性撕裂且伴有不稳定、经非手术治疗未改善的患者，以及伴有半月板斜坡撕裂等相关损伤的情况，如本18岁的一级橄榄球运动员，均需进行PCL重建。移植物的选择取决于外科医生和患者的偏好，股四头肌自体移植提供了一个可行的选择，具有理想的长期效果。
采集部分厚度的股四头肌肌腱自体移植物，清理残留的PCL残端，并用铰刀钻全内胫骨隧道以通过牵引缝线。利用一个辅助的低位前外侧入路钻股骨隧道以通过股骨牵引缝线。抽出牵引缝线，将移植物传入胫骨，对接至股骨，用干涉螺钉固定，并在胫骨纽扣上张紧。还识别出内侧半月板斜坡撕裂，并通过标准关节镜打结技术，使用90°缝合套索、聚二氧六环酮缝线（PDS）和缝合带以全内方式进行修复。手术后，患者开始使用PCL反弹支具进行PCL重建康复方案。由于半月板斜坡修复，在行走时膝关节伸直的情况下进行脚尖触地负重，持续6周。物理治疗（PT）侧重于早期股四头肌和髌骨活动以及主动辅助活动范围练习。
术后6个月，患者在PT方面持续进展，无重大问题。预计手术后约9至12个月可完全康复并重返运动，这与标准方案一致。
讨论/结论：本研究描述了一名一级运动员慢性PCL合并半月板斜坡撕裂的治疗方法。进一步采用股四头肌自体移植进行PCL重建，即使在伴有韧带或半月板重建（如内侧半月板斜坡修复）的情况下，也将有助于广泛治疗PCL损伤。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交物包含患者的豁免声明或其他书面批准形式以供发表。
