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Clinical outcomes of rectangular tunnel technique in posterior cruciate ligament reconstruction were comparable to the results of conventional round tunnel technique

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare clinical outcomes between the conventional round and rectangular tunnel techniques in single-bundle posterior cruciate ligament (PCL) reconstruction.

Methods

Twenty-seven and 108 patients who underwent PCL reconstructions using a rectangular dilator (Group 1) and rounded tunnel reamer (Group 2), respectively, were included. The exclusion criteria were having a concomitant fracture, osteotomy, subtotal or total meniscectomy, and no remnant PCL tissue. A 4:1 propensity score matching was performed. The knee laxity on stress radiography, International Knee Documentation Committee Subjective Knee Evaluation score, Tegner activity score and Orthopädische Arbeitsgruppe Knie score were evaluated.

Results

No significant differences were found between the groups in terms of clinical scores. (n.s.) The mean posterior translations were also not significantly different between the Group 1 and 2 (3.6 ± 2.8 and 3.8. ± 3.1 mm, respectively; n.s.). However, 3 patients (11.1%) in Group 1 and 15 patients (13.8%) in Group 2 showed posterior translation of > 5 mm. The combined posterolateral corner sling technique was performed for 27 patients (100%) in Group 1 and for 96 patients (88.9%) in Group 2. We found no significant difference in rotational stability at the final follow-up. One patient was found to have a femoral condyle fracture during rectangular femoral tunnel establishment, which was healed after screw fixation, without laxity, during follow-up. The intra- and inter-observer reliabilities of the radiological measurements ranged from 0.81 to 0.89.

Conclusion

Arthroscopic anatomical remnant-preserving PCL reconstruction using a rectangular dilator showed satisfactory clinical results and stability as compared with PCL reconstruction using a conventional rounded reamer. Rectangular tunnel technique in PCL reconstruction could be a good treatment option with theoretical advantage to be anatomic.

Level of evidence

Level IV.

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  1. Seong Hwan Kim and Woo-Sung Kim contributed this article equally.

Authors and Affiliations

  1. Departments of Orthopedic Surgery, Chung-Ang University Hospital, 102 Heukseok‑ro, Dongjak‑gu, Seoul, 06973, Republic of Korea

    Seong Hwan Kim & Jeuk Lee

  2. Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Gyeonggi-do, Republic of Korea

    Seong Hwan Kim, Woo-Sung Kim, Boo-Seop Kim, Hyun-Soo Ok, Jong-Heon Kim & Young-Bok Jung

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  1. Seong Hwan Kim
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Correspondence to Young-Bok Jung.

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This study was approved by the appropriate ethics committee of Hyundae General hospital (IRB No. HBIO IRB-2020-001) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Supplementary file1 Appendix Fig. 1 The shape of the cannulated rectangular dilator. (TIF 1749 KB)

167_2020_6381_MOESM2_ESM.tif

Supplementary file2 Appendix Fig. 2 An overview of the rectangular dilator is shown. The blue area was calculated using the radius for the rounded area (sector), as shown by the red arrow. The total area of the rectangular dilator was calculated by the rectangular area plus the rounded area. (TIF 373 KB)

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Kim, S.H., Kim, WS., Kim, BS. et al. Clinical outcomes of rectangular tunnel technique in posterior cruciate ligament reconstruction were comparable to the results of conventional round tunnel technique. Knee Surg Sports Traumatol Arthrosc 29, 3724–3734 (2021). https://doi.org/10.1007/s00167-020-06381-y

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