Causes analysis and coping strategies of posterior laxity after posterior cruciate ligament reconstruction
10.3760/cma.j.cn121113-20220624-00358
- VernacularTitle:膝关节后十字韧带重建术后后方松弛的原因与应对
- Author:
Weichuang CAI
1
;
Yihong XU
;
Weidong XU
Author Information
1. 海军军医大学附属长海医院关节骨病外科，上海 200433
- Keywords:
Posterior cruciate ligament reconstruction;
Postoperative complications;
Knee joint;
Joint instability;
Root cause analysis
- From:
Chinese Journal of Orthopaedics
2023;43(8):534-542
- CountryChina
- Language:Chinese
-
Abstract:
It is difficult to maintain the initial posterior stability of the knee after posterior cruciate ligament reconstruction. Residual posterior knee laxity after operation is a problem of PCL reconstruction. It not only results in abnormal kinematics of the knee, but also leads to secondary meniscus injury and cartilage degeneration of the affected knee, and eventually leads to knee osteoarthritis, which may especially happen with persistent and severe posterior laxity. The main reasons of residual posterior knee laxity after PCL reconstruction are: improper treatment of the posterolateral corner injury, poor positioning of the femoral tunnel, small tibial slope, and unreasonable postoperative rehabilitation. There are some concepts and technologies, such as using artificial ligaments, tibial tunnel fixation with suspensory device or suspensory device combined with interference screws, enlargement of graft diameter, all-inside reconstruction combined suture augmentation, slow and gradual postoperative rehabilitation, which can eliminate or reduce the postoperative residual laxity, in order to improve clinical outcomes after PCL reconstruction. For the patients with flat tibial slopes, double-bundle PCL reconstruction and concurrent slope-increasing tibial osteotomy is suggested. It can reduce the risk of posterior laxity and improve the stability of the knee after operation.
