Derrick M Knapik1,2, Varun Gopinatth3, Garrett R Jackson4, Jorge Chahla4, Matthew V Smith5,6, Matthew J Matava5,6, Robert H Brophy5,6. 1. Department of Orthopaedic Surgery, Division of Sports Medicine, Washington University in St. Louis, St. Louis, MO, USA. knapik@wustl.edu. 2. School of Medicine, Washington University in St. Louis, St. Louis, MO, USA. knapik@wustl.edu. 3. Saint Louis University, School of Medicine, St. Louis, MO, USA. 4. Midwest Orthopaedics at Rush University, Chicago, IL, USA. 5. Department of Orthopaedic Surgery, Division of Sports Medicine, Washington University in St. Louis, St. Louis, MO, USA. 6. School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Abstract
PURPOSE: In the setting of persistent instability or failed non-operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. METHODS: A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. RESULTS: Forty-five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans-tibial drilling and outside-in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. CONCLUSION: Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single-bundle reconstruction with hamstring autograft through a trans-tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. LEVEL OF EVIDENCE: Systematic review, Level IV.
PURPOSE: In the setting of persistent instability or failed non-operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. METHODS: A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. RESULTS: Forty-five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans-tibial drilling and outside-in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. CONCLUSION: Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single-bundle reconstruction with hamstring autograft through a trans-tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. LEVEL OF EVIDENCE: Systematic review, Level IV.
Authors: Thomas L Sanders; Ayoosh Pareek; Ian J Barrett; Hilal Maradit Kremers; Andrew J Bryan; Michael J Stuart; Bruce A Levy; Aaron J Krych Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-02-27 Impact factor: 4.342
Authors: Matthias Lahner; Tobias Vogel; Lars Victor von Engelhardt; Martin S Schulz; Michael J Strobel Journal: Arch Orthop Trauma Surg Date: 2011-11-05 Impact factor: 3.067
Authors: Nicholas I Kennedy; Robert F LaPrade; Mary T Goldsmith; Scott C Faucett; Matthew T Rasmussen; Garrett A Coatney; Lars Engebretsen; Coen A Wijdicks Journal: Am J Sports Med Date: 2014-08-04 Impact factor: 6.202
Authors: Colin J Anderson; Connor G Ziegler; Coen A Wijdicks; Lars Engebretsen; Robert F LaPrade Journal: J Bone Joint Surg Am Date: 2012-11-07 Impact factor: 5.284