Operative management of acute PCL injuries with associated pathology: long-term results

Eighteen consecutive patients with posterior cruciate ligament injury and associated pathology were reviewed. All were re-examined with an average follow up of 5.4 years (range: 3.5 to 7.5). Six posterior cruciate ligaments were repaired to the femur with multiple #2 nonabsorbable suture, and one "mop end" mid-substance tear was repaired with sutures in each stump. Seven mid-substance tears were repaired and augmented with the semitendinosus tendon, while four additional mid-substance tears were repaired and augmented with the semitendinosus tendon and a Dacron stent (Meadox). One medial meniscus was repaired and one was partially excised, and one lateral meniscus tear was partially excised. The anterior cruciate ligament was repaired to the tibia in two knees, left alone (interstitial tear) in two, and excised with extraarticular iliotibial band tenodesis augmentation in five. At follow up, arthrometer readings (Stryker) correlated well with clinical examination. The four knees with Dacron stent had a 0 to 1 mm difference at 90 degrees, while the failures had greater than 5 to 6 mm. Six of these were in the repair alone group and two were in the repair with semitendinosus augmentation group. Eight knees (44.5%) had radiographic changes primarily in the medial compartment. Using Hughston's perimeters to evaluate the results, objective 55.5% were rated good, 27.8% were rated fair, and 16.7% were rated poor or failures. Using Clancy's criteria, 22.2% were excellent, 22.2% were good, 44.5% were fair, and 11.1% were rated failures.(ABSTRACT TRUNCATED AT 250 WORDS)