Clinical comparison of remnant-preserving versus conventional transtibial single-bundle posterior cruciate ligament reconstruction combined with anatomical posterolateral reconstruction

Abstract

Background: Despite a preserved continuity of the original or attenuated posterior cruciate ligament (PCL) can be observed in most PCL insufficient patients, a few authors have presented several techniques preserving the remnant of the PCL or clinical results and the appropriate clinical role for this technique has not yet been established. The purpose of this study was to compare the clinical outcomes of transtibial PCL reconstruction with remnant preservation and conventional technique (without remnant preservation). Methods: We retrospectively evaluated 53 patients undergoing PCL reconstruction with simultaneous posterolateral complex (PLC) reconstruction: Group C, 23 patients, received conventional technique (without remnant preservation) and Group R, 33 patients, received remnant-preserving technique. The minimum follow-up period was 24 months in each group. Each patient was evaluated on the basis of the Lysholm knee score, Tegner activity scale, NRTA (nearly return to activity), IKDC knee score and grade, and posterior laxity on stress radiographs. Results: The mean side-to-side difference in posterior tibial translation, Lysholm knee score, and objective IKDC grade was similar between group C (4.4 ± 3.0 mm, 82.6 ± 11.0, A and B: 73.9%, respectively) and group R (4.1 ± 3.4 mm, 84.1 ± 10.7, A and B: 83.3%, respectively) (p = 0.761, 0.611, 0.755, respectively). The final Tegner activity scale, NRTA, and subjective IKDC score differed significantly between group C (3.5 ± 0.8, 43.5%, 64.5 ± 8.8, respectively) and group R (4.3 ± 1.1, 73.3%, 70.6± 7.9, respectively) (p = 0.007, 0.028, 0.012, respectively). Conclusion: In transtibial single-bundle PCL reconstruction combined with anatomical posterolateral corner reconstruction, with remnant preservation resulted in better activity-related clinical outcomes compared to without remnant preservation.