Objective
The objective of this study was to compare (1) rates of complications and reoperations, (2) posterior cruciate ligament (PCL) laxity and (3) patient-reported outcomes (PROs) among patients following all-inside single bundle posterior cruciate ligament reconstruction (PCLR) with and without independent suture tape reinforcement at minimum 2 year follow-up.
Methods
A retrospective cohort study from a prospectively gathered database was performed at a single academic institution from October 2012 to January 2019. Patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement and a minimum 2-year follow-up were identified. Medical records were reviewed for demographics, additional injuries, and concomitant procedures. Kneeling radiographs were collected at a minimum of 11 months postoperatively. PRO scores (including the International Knee Documentation Committee (IKDC), the Tegner activity and Lysholm scores), and physical exam findings were collected at a minimum of 2 years postoperatively.
Results
50 patients who underwent PCLR were identified: 19 patients (30.6 ± 12.7 years) with independent suture tape reinforcement and 31 patients (26.2 ± 9.0 years) without suture tape reinforcement. There was no difference between the groups regarding age, sex, BMI and KD grade. All included patients had a documented PCL injury on MRI with a grade 2+ or higher posterior drawer examination preoperatively. Postoperative range of motion was similar between the two groups: -0.6 ± 1.6º to 128.3 ± 9.4 º in the suture tape reinforcement group vs 0.2 ± 1.6 º to 124.5 ± 13.6 º in the control group (p=.591). At 2 years postoperatively, posterior drawer examination showed grade 1+ laxity in 4/19 (21%) of the suture tape cohort vs 6/31 (19%) of the control cohort. No grade 2 or grade 3 laxity was noted in either group. Kneeling radiographs showed no side-to-side difference between the two groups: 1.9 ± 1.8 mm in suture tape reinforcement group vs 2.6 ± 2.2 mm in control group (p=.360). There were no statistically significant differences between the suture tape and control groups in postoperative IKDC scores (79.3 and 79.6, respectively), Lysholm scores (87.5 and 84.3, respectively) and Tegner activity scores (5.6 and 5.7, respectively). One PCLR graft failure was documented in the suture tape group, and none in the control group. Overall, 5/19 (26%) suture tape patients and 3/31 (10%) control patients underwent reoperation (p=.232), including 2 superficial wound debridements, 2 multi-ligament reconstructions due to traumatic injuries, and 1 meniscal surgery in the suture tape group. There were 2 lysis of adhesions and 1 superficial wound debridement in the control group.
Conclusions
All-inside single bundle PCL reconstruction with independent suture tape reinforcement was performed safely with a low rate of complications, graft failure, and reoperation at minimum 2-year follow-up. All-inside posterior cruciate ligament reconstruction with and without independent suture tape reinforcement resulted in similar patient reported outcomes and postoperative laxity at 2-year follow-up.