Posterior cruciate ligament reconstruction for chronic lesions: clinical experience with hamstring versus ligament...

The aim of this study was to compare clinical and laximetric results in chronic, isolated posterior cruciate ligament (PCL) rupture repairs, using either a hamstring graft or an artificial ligament (ligament advanced reinforcement system (LARS®)).

Sixteen patients presenting with an isolated unilateral PCL rupture were included in this retrospective study. Initially, eight underwent a PCL reconstruction using a hamstring tendon autograft (hamstring group), and over a later period, eight further patients underwent a reconstruction using an artificial ligament with a new procedure.

Fifteen patients were male and one female, with an average age of 29.3 years. All patients were operated on within an average time of 18 months post-injury. Pre-operative posterior laxity was equivalent (p = 0.309), 18.25 mm on average for the hamstring group and 18.75 mm for the LARS group. With an average follow-up of 24 months, residual posterior laxity was significantly improved, decreasing from 18.25 to 7.37 mm for the hamstring group (p < 0.05) with a median at 7.5 mm and from 18.75 to 5.25 mm for the LARS group (p < 0.05) with a median at 5 mm. The improvement in laxity for the hamstring group was 60% and 71.5% for the LARS group. The LARS group compares favourably (p = 0.003 and 0.01). Tegner activity level improved significantly following ligamentoplasty, with no difference between the two groups (p = 0.4). Likewise, there was no significant difference in the Lysholm and IKDC scores between the two groups (p = 0.4).

The initial hypothesis of this study was proven correct. Nevertheless, a longer term study is necessary to assess the consequences of residual laxity in hamstring grafts and the long-term behaviour and tolerance of the LARS artificial ligament.