Summary

PCL reconstruction using all inside technique with Peroneus Longus graft had a good functional outcome, with no significant donor site morbidity.

Abstract

Introduction

Graft selection for posterior cruciate ligament reconstruction is a challenge in itself, requiring an appropriate size, geometric shape, tensile strength and a sufficient graft length. In addition to these anatomical features, graft fixation, fast graft incorporation, easy graft passage, and no harvest site morbidity are important aspects of an ideal graft for cruciate reconstruction. Due to the disadvantages of Hamstring tendon (HT) and Bone Patellar Tendon Bone (BPTB) autografts, the peroneus longus tendon (PL) is considered a better graft for PCL reconstruction.

Objective

The purpose of study is to evaluate clinico-radiological outcome of posterior cruciate ligament reconstruction using autologous Peroneus Longus graft with all inside technique.

Material And Methods

We used All inside technique of PCL reconstruction with PL graft in 23 patients of posterior cruciate ligament injury with mean age 38.6 years. We evaluated the patients for knee function and graft site morbidity for duration of 1 year. For functional scoring, we used International Knee Documentation Committee (IKDC) and Cincinnati score. For donor site morbidity evaluation, we used American Orthopedic Foot and Ankle Score (AOFAS) and Foot and ankle disability index (FADI) score. For radiological evaluation, MRI at 6 months post-operatively was taken into consideration to assess the healing of graft using Fegueroa's Score. For ligament laxity, Posterior Drawer and Posterior Lachman performed preoperatively and at 1 year postoperative.

Result: The IKDC and Cincinnati score in preoperative and p ostoperative patients showed a significant improvement. The mean IKDC Score (%) in the pre-operative phase was 46.67 ± 8.62. At one-year post-op, the mean IKDC Score (%) was 83.17 ± 2.99. The mean Cincinnati Score in pre-op was 181.67 ± 27.14. The mean Cincinnati Score at one-year post-op was 316.67 ± 19.66. The scores for donor site morbidity are within normal range. The mean AOFAS at 2 weeks post-op was 35.33 ± 5.75 which increased to 93.67 ± 2.42 at one-year post-op. The mean FADI score at 2 weeks post-op was 13.67 ± 2.94 and at one-year post-op was 95.67 ± 3.20 respectively. The mean MRI: Fegueroa's Score for radiological evaluation was 4.67 ± 0.52. All the patients had positive Posterior Drawer and Posterior Lachman which turned negative in 78.26 % of the patients, Grade 1 in 13.04 % and Grade 2 in 8.69 % of patients on examination at 1 year postoperative.

Conclusion

PCL reconstruction using all inside technique with Peroneus Longus graft had a good functional outcome, with no significant donor site morbidity.