2023 ISAKOS Biennial Congress In-Person Poster
Adults Undergoing Posterior Cruciate Ligament Reconstruction Have More Concomitant Multiligamentous Injury But Similar Failure Rates Compared With Adolescents
Ehab M Nazzal, MD, Pittsburgh UNITED STATES
Jenna L Dvorsky, BS, MS, Pittsburgh, PA UNITED STATES
Philipp W. Winkler , MD , Haslach AUSTRIA
Gian Andrea Lucidi, MD, Bologna ITALY
Bálint Zsidai, MD, Mölnlycke SWEDEN
Ian DeYoe Engler, MD, Portland, ME UNITED STATES
Kristian Samuelsson, Prof, MD, PhD, MSc, Mölndal, Västra Götalands län SWEDEN
James J. Irrgang, PT, PhD, FAPTA, Pittsburgh, Pennsylvania UNITED STATES
Volker Musahl, MD, Prof., Pittsburgh, Pennsylvania UNITED STATES
UPMC Freddie Fu Center for Sports Medicine, Pittsburgh, Pennsylvania, UNITED STATES
FDA Status Not Applicable
Summary
Adults undergoing PCL-R were more likely to have concomitant ACL injury and more advanced patellofemoral cartilage damage compared to adolescents, without differences in graft failure rates
Abstract
Introduction
The objective of this study was to compare the epidemiology, pathology, and outcomes of PCL reconstruction (PCL-R) in adults and adolescents. We hypothesized that there would be differences in failure rates and patient-reported outcomes (PROs) following PCL-R in adolescents and adults.
Methods
This was a retrospective study evaluating PCL-R after complete PCL rupture performed at a single institution from 2008-2020 in adolescents (10-19 years of age) and adults (>19 years of age). Exclusion criteria included PCL repair, nonoperative management, and insufficient data. Cartilage injury was graded based on the International Cartilage Repair Society (ICRS) classification. PROs included International Knee Documentation Committee Subjective Knee Form (IKDC SKF), Tegner Activity Level, Lysholm Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analogue Scale (VAS) for pain.
Results
21 adolescents and 55 adults with mean 6.1 years of follow-up were available for analysis. Follow-up for adolescents was greater than for adults (7.0 ± 3.5 years vs. 5.2 ± 3.1 years, respectively; p=0.03). The average time between injury and surgery for adults was greater than that of adolescents (77.6 ± 144 weeks vs. 20.6 ± 17.4 weeks, p=0.01). There was a higher rate of concomitant ACL injury in adults (56%) compared to adolescents (24%; p = 0.01). All medial meniscus tear types occurred more in adolescents than adults (p = 0.04). More adults (25%) had patellofemoral cartilage injury relative to the adolescent cohort (5%, p = 0.05). Graft failure was similar between adolescents and adults (10% vs. 20%, p = 0.5), and there were no significant differences in complication rates and PROs between cohorts.
Conclusion
Adults undergoing PCL-R were more likely to have concomitant ACL injury and more advanced patellofemoral cartilage damage compared to adolescents, without differences in graft failure rates. These findings show that both adults and adolescents can have similar outcomes from PCL-R, albeit with more concomitant pathology in the adult knee that may potentially be mitigated with earlier operative intervention.