PURPOSE: To compare the results of posterior cruciate ligament reconstructions by tibial inlay and tibial tunnel techniques. MATERIALS AND METHODS: Despite of conservative treatment, all patients (31 cases) had pain and grade 2 or more posterior instability. Posterior drawer test and posterior drawer stress radiography were performed. Clinically, Lysholm knee score and Tegner activity score were evaluated. RESULTS: In the tibial tunnel group, posterior drawer test demonstrated grade 1 instability in 7 cases, grade 2 in 4 cases, and grade 3 in 1 case at the last follow-up. In the tibial inlay group, there was grade 1 instability in 14 cases and grade 2 in 5 cases. On posterior drawer stress radiography, the mean side-to-side difference in measurement of the tibial tunnel group improved from 12.4 mm preoperatively to 4.0 mm at follow-up, and that of the tibial inlay group improved from 11.8 mm to 2.9 mm. Lysholm knee score and Tegner activity score improved to 86.8 points and 5.83 points, respectively, in the tibial tunnel group, and to 88.2 points and 5.84 points, in the tibial inlay group. CONCLUSION: PCL reconstruction with the tibial inlay technique tends to maintain better posterior stability, but there is no statistically significant difference between the two techniques. Further study may be required.
Follow-Up Studies ; Humans ; Inlays* ; Knee ; Posterior Cruciate Ligament* ; Radiography

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.
Anterior Cruciate Ligament/*pathology/radiography ; Arthralgia/etiology ; Humans ; Joint Diseases/diagnosis/*pathology/radiography ; Knee Joint/*pathology/radiography ; Male ; Middle Aged ; Posterior Cruciate Ligament/*pathology/radiography

Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Dronabinol ; Follow-Up Studies ; Joints ; Knee ; Knee Injuries ; Lateral Ligament, Ankle ; Menisci, Tibial ; Paint ; Posterior Cruciate Ligament* ; Radiography ; Synovial Membrane ; Tendons ; Transplants

PURPOSE: The purpose of this study is to provide the clinical results of arthroscopic posterior cruciate ligament (PCL) reconstruction with preservation of the original ligament with use of a posterior trans-septal portal and to compare the clinical outcomes between double-loop hamstring tendon autografts and Achilles tendon allografts. MATERIALS AND METHODS: 36 patients underwent PCL reconstruction with hamstring tendon autografts and with Achilles tendon allografts. At the final follow-up, patients were evaluated by four measurements: Lysholm knee scores, Telos stress radiography, IKDC grade, and second look arthroscopic examination. RESULTS: The postoperative mean Lysholm knee scores, the postoperative mean distances of posterior displacement by the Telos stress test, and the postoperative IKDC grades demonstrated statistically significant differences compared to the preoperative. The postoperative mean distances of posterior displacement by the Telos stress test and the postoperative IKDC grades demonstrated no statistically significant difference between two groups. CONCLUSION: The clinical results of arthroscopic PCL reconstruction with preservation of the original remnant ligament with use of a posterior trans-septal portal were good. The clinical outcomes of double-loop hamstring tendon autografts were equivalent to those of the Achilles tendon allograft.
Achilles Tendon ; Allografts ; Autografts ; Exercise Test ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Posterior Cruciate Ligament* ; Radiography ; Tendons

Ganglion cysts are more commonly associated with the anterior cruciate ligament than the posterior cruciate ligament (PCL). A literature review showed that all reported cases of ganglion cysts to date involved adults. We report a rare case of ganglion cyst in the PCL of a four-year-old boy, and discuss its aetiology, clinical presentation, imaging features and management. Ganglion cysts of the PCL may be confused with meniscal cysts arising from tears of the posterior horn of the medial meniscus on magnetic resonance (MR) imaging. Hence, the posterior horn of the medial meniscus has to be carefully evaluated to rule out a tear. MR imaging is the method of choice to confirm diagnosis, and arthroscopic resection is a safe treatment modality even in children.
Arthroscopy ; Child, Preschool ; Ganglion Cysts ; diagnosis ; surgery ; Humans ; Knee Joint ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Posterior Cruciate Ligament ; injuries ; pathology ; Radiography

OBJECTIVE: The purpose of our study was to evaluate the overall prevalence and clinical significance of interposition of the posterior cruciate ligament (PCL) into the medial compartment of the knee joint in coronal magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed 317 consecutive patients referred for knee MRI at our institution between October 2009 and December 2009. Interposition of the PCL into the medial compartment of the knee joint on proton coronal MRI was evaluated dichotomously (i.e., present or absent). We analyzed the interposition according to its prevalence as well as its relationship with right-left sidedness, gender, age, and disease categories (osteoarthritis, anterior cruciate ligament tear, and medial meniscus tear). RESULTS: Prevalence of interposition of PCL into the medial compartment of the knee joint was 47.0% (149/317). There was no right (50.0%, 83/166) to left (43.7%, 66/151) or male (50.3%, 87/173) to female (43.1%, 62/144) differences in the prevalence. There was no significant association between the prevalence and age, or the disease categories. CONCLUSION: Interposition of the PCL into the medial compartment of the knee joint is observed in almost half of patients on proton coronal MRI of the knee. Its presence is not associated with any particular factors including knee pathology and may be regarded as a normal MR finding.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Image Processing, Computer-Assisted ; Knee Joint/*radiography ; *Magnetic Resonance Imaging ; Male ; Menisci, Tibial/radiography ; Middle Aged ; Osteoarthritis/diagnosis/epidemiology/radiography ; Posterior Cruciate Ligament/*radiography ; Prevalence ; Retrospective Studies ; Young Adult

PURPOSE: The purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft. MATERIALS AND METHODS: Twelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0degrees, 45degrees, 90degrees, and 120degrees). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees. RESULTS: Between 45degrees and 120degrees of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p<0.001). In cadaveric experiments using pressure-sensitive film, the maximum contact pressure for the modified inside-out and outside-in technique was significantly lower than that for the conventional inside-out technique (p=0.024 and p=0.017). CONCLUSION: The conventional inside-out technique results in a significantly lesser GTA and higher stress at the intra-articular aperture of the femoral tunnel than the outside-in technique. However, the results for the modified inside-out technique are similar to those for the outside-in technique.
Cadaver ; Femur/radiography/surgery ; Humans ; *Imaging, Three-Dimensional ; Knee Joint/surgery ; Models, Anatomic ; Posterior Cruciate Ligament/radiography/*surgery ; Reconstructive Surgical Procedures/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed