Thick Graft Versus Double-Bundle Technique on Posterior Cruciate Ligament Reconstruction: Experimental Biomechanical Study with Cadavers

Maradei-Pereira, João Alberto Ramos; Kokron, Alexandre Estevão Vamos; Pereira, César Augusto Martins; Amatuzzi, Marco Martins

doi:10.1016/j.rboe.2017.12.010

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Sumário

Original Article • Rev. bras. ortop. 54 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.rboe.2017.12.010 copy

Thick Graft Versus Double-Bundle Technique on Posterior Cruciate Ligament Reconstruction: Experimental Biomechanical Study with Cadavers^* * Study conducted at the Medical Research Laboratory (LIM-41), Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. Originally published by Elsevier.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the biomechanical effect of graft thickness compared with the double-bundle technique on posterior cruciate ligament (PCL) reconstruction in human cadaveric knees.

Methods

A total of 9 human cadaveric knees were tested in 5 conditions: intact knee (INT); single-bundle reconstruction with a 10-mm quadriceps tendon (SB); double-bundle reconstruction with a 10 mm-quadriceps tendon for the anterolateral bundle and a 7-mm doubled semitendinosus tendon for the posteromedial bundle (DB); single-bundle reconstruction with a 10-mm quadriceps tendon plus a 7-mm doubled semitendinosus tendon (SBT); and PCL-deficient (NoPCL). The posterior tibial translation (PTT) was measured in response to a 134-N posterior tibial load at 0º, 30º, 60º e 90º of knee flexion.

Results

The PTT values of the DB and SBT techniques were always significantly lower (better stability) than those of the SB technique. The PTT values of the SBT technique were significantly lower than those of the DB technique at 60º (p = 0.005) and 90º (p = 0.001).

Conclusions

Graft enlargement improves knee stability in isolated PCL reconstructions, whereas the graft division in the two-bundle technique worsens this stability at 60º and 90º of knee flexion. The findings of the present study suggest that knee stability in PCL reconstructions may be improved with the use of thicker grafts in the SB technique rather than performing the DB technique.

Keywords
knee injuries; posterior cruciate ligament; biomechanical phenomena; cadaver; posterior cruciate ligament reconstruction

Flexion angle			PTT (mm)
Flexion angle	Intact	Injured	SB	DB	SBT
0°	9.48 (1.81) [8.08-10.86]	12.30 (2.72) [10.21-14.40]	10.46 (2.12) [8.83-12.08]	8.83 (1.60) [7.61-10.06]	9.55 (1.76) [8.19-10.90]
30°	10.98 (1.93) [9.49-12.46]	17.36 (3.24) [14.87-19.85]	13.70 (2.35) [11.89-15.51]	12.00 (1.97) [10.49-13.52]	10.96 (2.63) [8.93-12.98]
60°	8.92 (1.24) [7.97-8.87]	17.87 (3.01) [15.55-20.18]	12.60 (1.97) [11.09-14.12]	11.18 (1.82) [9.78-12.58]	9.87 (2.06) [8.29-11.46]
90°	8.31 (1.26) [7.34-9.28]	19.28 (2.33) [17.49-21.07]	12.83 (2.16) [11.17-14.49]	11.67 (2.22) [9.96-13.37]	10.27 (2.43) [8.40-12.14]

	Intact	Injured	SB	DB	SBT
Intact	-	x	x	x	x
Injured	p = 0.001	-	x	x	x
SB	p = 0.022	p = 0.003	-	x	x
DB	p = 0.180	p < 0.001	p = 0.001	-	x
SBT	p = 0.803	p = 0.006	p = 0.036	p = 0.183	-

	Intact	Injured	SB	DB	SBT
Intact	-	x	x	x	x
Injured	p < 0.001	-	x	x	x
SB	p < 0.001	p = 0.001	-	x	x
DB	p = 0.085	p < 0.001	p = 0.001	-	x
SBT	p = 0.980	p = 0.001	p = 0.002	p = 0.140	-

	Intact	Injured	SB	DB	SBT
Intact	-	x	x	x	x
Injured	p < 0.001	-	x	x	x
SB	p < 0.001	p < 0.001	-	x	x
DB	p = 0.001	p < 0.001	p = 0.003	-	x
SBT	p = 0.116	p < 0.001	p = 0.001	p = 0.005	-

	Intact	Injured	SB	DB	SBT
Intact	-	x	x	x	x
Injured	p < 0.001	-	x	x	x
SB	p < 0.001	p < 0.001	-	x	x
DB	p < 0.001	p < 0.001	p = 0.014	-	x
SBT	p = 0.011	p < 0.001	p = 0.001	p = 0.001	-

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence João Alberto Ramos Maradei-Pereira, MD, MSc, Faculdade de Medicina, Universidade Federal do Pará, Praça Camilo Salgado, 01, Umarizal, Belém, PA, 66050-060 Brazil (e-mail: jamaradei@ufpa.br).