Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 12, pp 1723–1730 | Cite as

Arthroscopic posterior cruciate ligament reconstruction by using hamstring tendon autograft and transosseous screw fixation: minimal 3 years follow-up

  • Seyed Taghi Norbakhsh
  • Zohreh Zafarani
  • Arvin Najafi
  • Hamidreza Aslani
Arthroscopy and Sports Medicine



The aim of this trial is to prospectively evaluate the outcomes of PCL reconstruction by means of quadruple hamstring tendon autograft with a double-fixation method at minimal 3-year follow-up.

Materials and methods

Only patients who underwent PCL reconstruction without any other concomitant injury were included in this study. A hamstring tendon graft is composed of a quadruple-stranded gracilis tendon and semitendinosus tendon about 10 cm in length. An arthroscopic technique via a two incision and a double-fixation method was applied. Clinical evaluations were performed for 52 patients. Clinical assessment of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle evaluation, and radiographic investigation.


On the Lysholm knee score, 90 % of the patients displayed good or excellent rating in the final assessment. In the IKDC rating analyses, 60 % of the patients demonstrated 3–5-mm ligament laxity. For the IKDC final rating, 81 % were normal or nearly normal. Seventy-nine percent of the cases revealed less than a 10-mm difference in thigh girth between their reconstructed and contra lateral limbs.


Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft provides acceptable outcomes at a minimum 3-year follow-up. The four-stranded hamstring tendon graft is suitable in graft size and results in minimal harvesting morbidity. We recommend that quadruple hamstring tendon graft be chosen for PCL reconstruction to achieve good ligament reconstruction. A double-fixation method which has been applied in this trial can be used to provide rigid fixation.


Arthroscopy Posterior cruciate ligament Hamstring tendon Graft 


Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MPEG 59056 kb)


  1. 1.
    Harner CD, Livesay GA, Kashiwaguchi S, Fujie H, Choi NY, Woo SL (1995) Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res 13(3):429–434PubMedCrossRefGoogle Scholar
  2. 2.
    Miyasaka KC, Daniel DM, Stone ML (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8Google Scholar
  3. 3.
    Shelbourne KD, Davis TJ, Patel DV (1999) The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med 27(3):276–283 PubMed PMID: 10352760PubMedGoogle Scholar
  4. 4.
    Chen B, Gao S (2009) Double-bundle posterior cruciate ligament reconstruction using a non-hardware suspension fixation technique and 8 strands of autogenous hamstring tendons. Arthroscopy 25(7):777–782PubMedCrossRefGoogle Scholar
  5. 5.
    Kim SJ, Kim TE, Jo SB, Kung YP (2009) Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques. J Bone Joint Surg Am 91(11):2543–2549PubMedCrossRefGoogle Scholar
  6. 6.
    Cross MJ, Powell JF (1984) Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med 12(4):292–297 PubMed PMID: 6476188PubMedCrossRefGoogle Scholar
  7. 7.
    Shino K, Horibe S, Nakata K, Maeda A, Hamada M, Nakamura N (1995) Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br 77(6):895–900PubMedGoogle Scholar
  8. 8.
    Rubinstein RA Jr, Shelbourne KD, McCarroll JR, VanMeter CD, Rettig AC (1994) The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med 22(4):550–557 PubMed PMID: 7943523PubMedCrossRefGoogle Scholar
  9. 9.
    Keller PM, Shelbourne KD, McCarroll JR, Rettig AC (1993) Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 21(1):132–136 PubMed PMID: 8427355PubMedCrossRefGoogle Scholar
  10. 10.
    Cooper DE, Stewart D (2004) Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up. Am J Sports Med 32(2):346–360PubMedCrossRefGoogle Scholar
  11. 11.
    Harner CD, Höher J (1998) Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 26(3):471–482 Review PubMed PMID: 9617416PubMedGoogle Scholar
  12. 12.
    Race A, Amis AA (1994) The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 27(1):13–24PubMedCrossRefGoogle Scholar
  13. 13.
    Aït Si Selmi T, Fithian D, Neyret P (2006) The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee 13(5):353–358 Epub 2006 Aug 28PubMedCrossRefGoogle Scholar
  14. 14.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMedGoogle Scholar
  15. 15.
    Deehan DJ, Salmon LJ, Russell VJ, Pinczewski LA (2003) Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up. Arthroscopy 19(9):955–962PubMedCrossRefGoogle Scholar
  16. 16.
    Chen CH, Chen WJ, Shih CH (2002) Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 18(6):603–612 PubMed PMID: 12098121PubMedCrossRefGoogle Scholar
  17. 17.
    Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus. An estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop Relat Res 240:129–136PubMedGoogle Scholar
  18. 18.
    Shelton WR, Papendick L, Dukes AD (1997) Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 13(4):446–449PubMedCrossRefGoogle Scholar
  19. 19.
    Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17(1):9–13PubMedCrossRefGoogle Scholar
  20. 20.
    Clancy WG Jr, Pandya RD (1994) Posterior cruciate ligament reconstruction with patellar tendon autograft. Clin Sports Med 13(3):561–570PubMedGoogle Scholar
  21. 21.
    Fulkerson JP, Langeland R (1995) An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthroscopy 11(2):252–254PubMedCrossRefGoogle Scholar
  22. 22.
    DeLee JC, Craviotto DF (1991) Rupture of the quadriceps tendon after a central third patellar tendon anterior cruciate ligament reconstruction. Am J Sports Med 19(4):415–416 PubMed PMID: 1897661PubMedCrossRefGoogle Scholar
  23. 23.
    Christen B, Jakob RP (1992) Fractures associated with patellar ligament grafts in cruciate ligament surgery. J Bone Joint Surg Br 74(4):617–619PubMedGoogle Scholar
  24. 24.
    Aglietti P, Buzzi R, Zaccherotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22(2):211–217 (discussion 217-8). PubMed PMID: 8198189PubMedCrossRefGoogle Scholar
  25. 25.
    Lipscomb AB, Johnston RK, Snyder RB, Warburton MJ, Gilbert PP (1982) Evaluation of hamstring strength following use of semitendinosus and gracilis tendons to reconstruct the anterior cruciate ligament. Am J Sports Med 10(6):340–342 PubMed PMID: 7180953PubMedCrossRefGoogle Scholar
  26. 26.
    Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557PubMedGoogle Scholar
  27. 27.
    Rowden NJ, Sher D, Rogers GJ, Schindhelm K (1997) Anterior cruciate ligament graft fixation. Initial comparison of patellar tendon and semitendinosus autografts in young fresh cadavers. Am J Sports Med 25(4):472–478 PubMed PMID: 9240980PubMedCrossRefGoogle Scholar
  28. 28.
    Pinczewski LA, Clingeleffer AJ, Otto DD, Bonar SF, Corry IS (1997) Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament. Arthroscopy 13(5):641–643PubMedCrossRefGoogle Scholar
  29. 29.
    Karlson JA, Steiner ME, Brown CH, Johnston J (1994) Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Comparison of through-the-condyle and over-the-top graft placements. Am J Sports Med 22(5):659–666 PubMed PMID: 7810790PubMedCrossRefGoogle Scholar
  30. 30.
    Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23(6):706–714 PubMed PMID: 8600739PubMedCrossRefGoogle Scholar
  31. 31.
    Wang CJ, Chen HS, Huang TW (2003) Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear. Injury 34(10):747–751PubMedCrossRefGoogle Scholar
  32. 32.
    Shino K, Nakagawa S, Nakamura N, Matsumoto N, Toritsuka Y, Natsu-ume T (1996) Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: one-incision technique with Endobutton. Arthroscopy 12(5):638–642PubMedCrossRefGoogle Scholar
  33. 33.
    Pinczewski LA, Thuresson P, Otto D, Nyquist F (1997) Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws. Arthroscopy 13(5):661–665PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Seyed Taghi Norbakhsh
    • 1
  • Zohreh Zafarani
    • 1
  • Arvin Najafi
    • 2
  • Hamidreza Aslani
    • 1
  1. 1.Shahid Beheshti University of Medical SciencesTehranIran
  2. 2.Tehran University of Medical SciencesTehranIran

Personalised recommendations