2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


No Difference in Postoperative Knee Stability between Cortical Button With Suture Tape Augmentation Versus Interference Screw Fixation for Single-Bundle PCL Reconstruction

Raimundo Vial, MD, Santiago CHILE
Danilo Quilodran, MD, Santiago CHILE
Raimundo Bosselin, DC CHILE
Maria Tuca, MD, Santiago CHILE
Maximiliano Scheu, MD, MMSc, Santiago CHILE
Xabier Carredano, MD, Santiago, Lo Barnechea CHILE
Agustín León, MD, Santiago CHILE
Juan Jose Valderrama, MD, Santiago CHILE

Hospital Mutual de Seguridad CChC, Santiago, CHILE

FDA Status Cleared

Summary

Retrospective cohort of patients with allograft single-bundle PCL reconstruction comparing two femoral fixation methods: cortical button with suture tape augmentation v/s interference screw fixation. Patients from each group were matched by age, sex, injury and reconstructions performed. No difference in postoperative knee stability or range of motion was identified.

Abstract

Introduction

Within Posterior Cruciate Ligament Reconstruction (PCL-R), various techniques of single bundle PCL-R have been described. Single-bundle transtibial PCL-R is one of these alternatives, particularly useful in cases involving multiligament knee reconstructions that require multiple bone tunnels. Two commonly used techniques for single-bundle reconstruction are 1) Achilles allograft reconstruction and 2) Soft tissue allograft using a cortical button for femoral fixation with suture tape internal bracing.
To date, there is insufficient evidence to determine which technique yields better postoperative outcomes. This study aims to identify whether either of these techniques is superior in terms of postoperative knee stability, knee range of motion, and surgical complications.

Methodology

This retrospective matched cohort study analyzed patients who underwent single-bundle PCL-R with either Achilles allograft using femoral interference screw fixation (IS) or peroneus longus allograft using femoral cortical button fixation with suture tape internal bracing (CB+IB) between 2016 and 2024. Out of 32 CB+IB cases and 108 IS cases with at least 6 months of follow-up, 23 patients were matched based on injured (MRI) and reconstructed ligaments, age, and sex. Postoperative rehabilitation followed the same protocol for all cases, including the use of a dynamic force PCL brace. Knee stability, range of motion (ROM), and re-interventions were assessed at the 6-month follow-up visit. Knee stability was evaluated using the IKDC physical exam classification, with grades A or B classified as stable and grades C or D as unstable. Student’s t test was used to compare continuous variables, Chi-square test was used to compare the frequency of residual postoperative instability, Cochrane’s Q test to compare pre- versus postoperative stability changes, and Mann-Whitney U test to compare postoperative knee ROM between the two groups

Results

The mean age for the IS (42.2 ± 12.3) and CB+IB (44.7 ± 13.3) groups was similar (p=0.51). Of the 23 cases included in each group, 2 were female. On each group 7 cases had isolated PCL injuries, 3 cases had a PCL + posterolateral corner injury, 3 cases had PCL + posteromedial corner injury, 2 Schenck II, 1 Schenck III-L, 5 Schenck III-M, and 2 Schenck IV injuries. Preoperative IKDC grading was similar between groups (p=0.29).
At the 6-month follow-up, no significant differences were found between groups for frequency of IKDC grading A+B (CB:96%, IS 96%, p=1), IKDC change from preoperative state (p=0.22), knee flexion or extension ROM (p=0.55 and p=0.56, respectively), or reintervention rate (p=0.61). Additionally, no differences were observed in the subgroup analysis of isolated PCL-R versus multiligament knee reconstructions.

Conclusion

In this study comparing different surgical techniques for single-bundle PCL-R, we found no significant differences in postoperative knee stability, knee ROM, or reintervention rates between the IS and CB+IB groups. Based on these findings, the choice between these two techniques could be made according to the surgeon's preference, depending on surgical experience and patient-specific factors without compromising clinical stability.