Sandwich-style posterior cruciate ligament reconstruction

The purpose of this study was to evaluate the results of a sandwich-style posterior cruciate ligament (PCL) reconstruction, namely double-bundle PCL reconstruction with 8 strands of hamstring tendons and remnant preservation.

Eighteen cases of isolated chronic PCL rupture were reconstructed arthroscopically with 8 strands of autogenous hamstring tendons by way of 2-bundle and 4-tunnel reconstruction, as well as preservation of the remnant between the 2 reconstructed bundles. Quadruple-stranded semitendinosus tendon was used to reconstruct the anterolateral bundle, and quadruple-stranded gracilis tendon was used to reconstruct the posteromedial bundle. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. The patients were followed up for a minimum of 2 years and evaluated according to the International Knee Documentation Committee (IKDC), Lysholm, and Tegner rating scales.

At a minimum of 2 years after surgery, 17 patients (94.4%) had a negative posterior drawer test and 1 had a 1+ posterior drawer test. The mean KT-1000 examination results (MEDmetric, San Diego, CA) changed from 9.3 +/- 1.4 mm preoperatively to 0.7 +/- 0.9 mm postoperatively (P < .001). According to the IKDC knee examination form, the results were graded as normal in 16 patients (88.9%) and nearly normal in 2 (11.1%). The IKDC subjective results increased from 64.1 +/- 3.3 to 95.6 +/- 3.1 (P < .001), and the Lysholm score increased from 58.6 +/- 4.4 to 94.9 +/- 3.6 (P < .001). The mean Tegner score was 7.1 before injury, 5.6 before surgery, and 6.9 at the last follow-up.

Arthroscopic sandwich-style PCL reconstruction can yield normal results in 88.9% of patients and nearly normal results in 11.1% at a minimum of 2 years.