Injuries of the posterior cruciate ligament have almost universally been treated nonoperatively in the past due to indignity of this complex structure. Recent studies have shown new informations on the anantomical, histological, biomechanical characteristics of the Posterior cruciate ligament PCL), and thereby interest of reconstruction surgery is increasing. But intraarticular PCL reconstruction still remains one of the most challenging problems in knee surgery. Although, various types of graft and surgical techniques have been used for reconstruction, results of surgery has been variable. In this study, three different methods of graft fixation for PCL reconstruction are evaluated biomechanically to determine the effect on mechanical property of reconstructed PCL using 30 porcine knees. Grafts used in this study were bone-patellar tendon-bone fixed with interference screw and Achilles tendon tied with suture. Additionally, five original PCLs were also tested by Instron universal testing instrument to determine its mechanical proprety. Tensile test was performed at extended knee position. It was demonstrated that mechanical strength of bone-patellar tendon-bone graft is superior to that of Achilles tendon graft. All of the failures of bone-patellar tendon-bone graft and Achilles tendon graft occurred at tibial fixation site whereas original PCLs which failed at proximal midsubstance of ligament. In conclusion, tensile strength of Bone-patellar tendon-bone graft used for PCL reconstruction is higher than that of Achilles tendon but latter can be used in terms of as clinical meanings.
Achilles Tendon ; Bone-Patellar Tendon-Bone Grafts ; Knee ; Ligaments ; Posterior Cruciate Ligament* ; Sutures ; Tensile Strength ; Transplants*

PURPOSE: We report the result of arthroscopic ACL reconstruction using a bone-patellar tendon-bone allograft with the Flip technique. MATERIALS AND METHODS: From October 2002 to August 2003, 21 cases of arthroscopic ACL reconstruction were performed using the Flip technique. The average age and follow-up period was 29.3 years old (17-46) and 13.7 months (10-20), respectively. Physical examinations, such as Lachman test, pivot shift test and measured a quantitative KT-2000 testing, the Lysholm, IKDC, and Tegner scores were performed and the results were compared with those of the final evaluation. RESULTS: Final results of the Lachman test were 1+ in 9 patients, 2+ in 1 patient, and the pivot shift was positive in only 1 patient. Preoperative evaluation revealed an average score with a KT-2000 of 6.8 mm, a Lysholm score of 50.4, an IKDC score below C in all cases and a Tegner score of 3.0. However, the final results showed a KT-2000 of 3.2 mm, a Lysholm score of 86.2, an IKDC score above B in all cases and a Tegner score of 6.6. CONCLUSION: Arthroscopic ACL reconstruction using allogeneic bone-patellar tendon-bone graft with the Flip technique showed excellent functional results with a resolution of the graft-tunnel length mismatch.
Allografts* ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Physical Examination

PURPOSE: We compared the clinical and radiological RESULTS of two patient-groups who had had PCL reconstruction for grade III PCL injury using the autogenous bone-patellar tendon-bone graft at the isometric point and at the anatomical point of femoral condyle. MATERIALS AND METHODS: Of 31 patients who were involved in this study, 20 patients had consecutive isometric PCL reconstructions between June 1993 and May 1995(group 1), And 11 patients had anatomi- cal PCL reconstructions between 1995 and 1997(group 2). We evaluated the clinical results using the Lysholm knee scoring system and measured the posterior translation of the tibial condyle on the posterior stress lateral radiographs. RESULT: The average posterior translation at the final follow-up was 7mm in group 1 and 5.9mm in group 2. The Lysholm knee score was 89 points in group 1, and 92 point in group 2. However, there wasn't any statistically significant difference in clinieal and radiological results between the two groups. SUMMARY: The clinical and radiological results can be influenced by several factors inherent to arthro-scopically assisted PCL reconstruction. Although it seems that initial knee kinematics can be improved by more distal PCL graft placement, there may be little effect to the final clinical and radiological results according to the femoral tunnel positions.
Biomechanical Phenomena ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Knee ; Tendons* ; Transplants*

PURPOSE: The purpose of this study was to correlate radiological analysis(as divergence of femoral tun-nel and interference screw and tunnel placement) with clinical results(as physical examination, Lysholm knee scoring scale, and side to side difference of anterior displacement in an arthrometer). MATERIALS AND METHODS: This study reviewed radiological and clinical results in 48 endoscopic single-incision ACL reconstruction, using autogenous bone-patellar tendon-bone graft and interference screw fixation, between January 1995 and October 1997. We measured the femoral divergence in antero-poste-rior and lateral views of the knee(APD/LD), the angle between a line through the longitudinal axis of dis-tal femoral shaft, and the axis of femoral tunnel in antero-posterior and lateral views(APFT/LFT). We also measured the placement of a tunnel in antero-posterior and lateral views. RESULTS: Significant correlation was present between APD and APFT(negatively) and between LD and LFT(positively), while other variables had no significant correlation. Furthermore, there was no signifi-cant correlation between divergence and clinical results. Clinical results correlated positively with posteri-or femoral tunnel placement on lateral radiographs and negatively with excessive anterior tibial tunnel placement. Therefore, when femoral tunnels were placed at least 60% posterior along the Blumenssat's line and tibial tunnels were placed at least 20% posterior along the tibial plateau, 77.1% of the patients had good or excellent Lysholm score and 80% of the patients had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. When the above criteria were not met, however, only 53.8% of the patients had good or excellent Lysholm score and 53.8% had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. CONCLUSIONS: This close correlation indicated that satisfactory radiographic tunnel position influences the outcome of an ACL reconstruction.
Anterior Cruciate Ligament* ; Axis, Cervical Vertebra ; Bone-Patellar Tendon-Bone Grafts* ; Humans ; Knee ; Physical Examination

PURPOSE: The objective of this study was to evaluate the initial fixation strength of press-fit technique compared with titanium and biodegradable interference screws in ACL reconstruction using bone-patellar tendon-bone grafts. MATERIALS AND METHODS: Fifty porcine lower limbs were used. The graft in the press-fit group was harvested with a hollow oscillating saw to obtain a consistent and complete circular shape and that in the interference screw group was obtained with a conventional oscillating saw. With preload of 20 N, the specimens underwent 250 loading cycles between 0-2 mm of displacement. Thereafter, the specimens were loaded to failure after restoration of the preload. RESULTS: During the cyclic loading, none of press-fit or interference screw fixations failed and there was no significant difference in maximum loads between the groups. In groups of press-fit fixation with diameter of bone plug being larger that that of the femoral tunnel by 1.4 mm, the ultimate failure load was comparable with that of the titanium or biodegradable interference screw groups. The complete circular shape and increased diameter of the bone plug seemed to contribute the strong initial fixation. CONCOUSION: Press-fit fixation technique provides a secure and consistent fixation strength comparable with the metal or biodegradable interference screws.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Bone-Patellar Tendon-Bone Grafts ; Knee ; Lower Extremity* ; Titanium ; Transplants

PURPOSE: To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. MATERIAL AND METHOD: ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 mm. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. RESULT: Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. CONCLUSIONS: Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.
Arthritis* ; Bone-Patellar Tendon-Bone Grafts ; Contusions ; Follow-Up Studies ; Humans ; Joints ; Knee ; Osteoarthritis ; Prognosis ; Tomography, Emission-Computed, Single-Photon*

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0degrees, 15degrees, 30degrees, 60degrees, and 90degrees of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Biomechanical Phenomena ; Bone-Patellar Tendon-Bone Grafts ; Joints ; Knee ; Tendons ; Translations ; Transplants

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Bone-Patellar Tendon-Bone Grafts* ; Follow-Up Studies* ; Humans ; Incidence ; Patellar Ligament ; Tendons ; Transplants

Traditionally, evaluation after ACL reconstruction has been focused on physical characteristics and measures of knee stability. Recently, however, reliance on such criteria has been refuted based on the lack of a strong relationship between these measures and both the patient s perception of knee function and return to sports activity. In present study, preoperative and postoperative physical examinations, isokinetic dynamometer, arthrometer test and functional tests were performed on 17 patients with chronic anterior cruciate ligament tears treated by arthroscopic reconstruction using autogenous bone-patellar tendon-bone graft with at least 1 year of follow-up. Muscle power, joint stability and functional recovery were checked for functional evaluation by specific methods. Lysholm score rating scale and functional tests (single leg hop test, vertical jump test, timed single jump test) were performed preoperatively and 6, 12 months postoperatively. Pivot-shift test, Lachman test, anterior drawer test, thigh circumference index and Cybex II+ isokinetic dynamometer test were done preoperatively and at 3, 6, 12 months postoperatively. KT-2000 arthrometer test was done at last follow-up. Lysholm score has showed increasing tendency at 6, 12 months postoperatively (p < 0.01). In Cybex study, deficit percentage of peak torque and total work of the quadriceps and hamstrings was same or slightly decreased at 3, 6 months, but have decreased at 1 year follow-up (p < 0.01). Functional tests and physical examinations have also showed improving tendency at 12 months (p < 0.01). Arthrometer test revealed no significant laxity of the knee joint at last follow-up. In conclusion, muscle strengh and functional capacity in ACL reconstructed knee showed significant improvement at postoperative one year compared with preoperative status. It was considered that arthroscopic reconstruction using autogenous bone-patellar tendon-bone graft is one of the useful method for chronic anterior cruciate ligament injury.
Anterior Cruciate Ligament ; Autografts* ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Humulus ; Joints ; Knee ; Knee Joint ; Leg ; Muscle Strength* ; Patellar Ligament* ; Physical Examination ; Sports ; Thigh ; Torque

Combined rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament is common. Since O Donoghue described this combined injury in 1950, it has been referred to as O Donoghue's triad. But the rupture of the patellar tendon is a relatively uncommon form of injury, particularly in a young, well-conditioned athlete. Baker (1980) presented a case of O' Donoghue' s triad with a rupture of the patellar tendon. We present an unusual case of patellar tendon rupture associated with rupture of anterior cruciate ligament, medial collateral ligament, lateral collateral ligament and lateral meniscus. This case differs from Baker's case and has not yet been reported in the literature. The senior author performed arthroscopic partial menisectomy, patellar tendon repair by Matava's method and arthroscopic anterior cruciate ligament reconstruction, using the autogenous bone-patellar tendon-bone graft from the controlateral knee. The clinical results were good, and as far as the authors have reviewed, no report has been published about this rare injury. So we report this case with a review of the literature.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament* ; Athletes ; Bone-Patellar Tendon-Bone Grafts ; Collateral Ligaments ; Humans ; Knee ; Lateral Ligament, Ankle ; Menisci, Tibial* ; Patellar Ligament* ; Rupture*