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Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal
Shahir Shahibullah1, Suhari Juhari1, Farhan Yahaya1
1Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah Malaysia.
Introduction:
Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also thought to lower the risk of neurovascular injuries. The aim of this study was to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute.
Methods:
This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation.
Results:
A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2 years. Mean time from injury to surgery was 20 months. Mean follow-up was 41.2 months (range, 13-72 months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p < 0.001). Knee range of movement was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p = 0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p < 0.001). KOOS score improved from 65.1 to 77.2 (p = 0.196). One patient required manipulation under anesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at the final follow-up.
Conclusion:
Greater visualization of the PCL tibial attachment minimizes the 'killer turn' giving a huge advantage to this technique. Arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study, it shows that post-operative clinical and functional outcomes improved significantly.
