Graft Force and Pressure on Graft over Tibial Tunnels In PCL Reconstruction The posterior cruciate ligament (PCL) is the primary stabilizer of the knee joint and the major restraint to the posterior tibial translation. PCL injury has been a common traumatic knee injury in Taiwan especially in motorcycle accident. Higher-grade posterior instability due to PCL insufficiency has been considered for surgical reconstruction to maintain adequate knee activities and prevent further osteoarthritis. The grafts for PCL reconstruction include allograft and autograft. Due to allografts not always available in Taiwan, autografts remained the grafts of choice for PCL reconstruction among majority of orthopedists. In the traditional tunnel method for PCL reconstruction, bone-patellar tendon-bone, hamstrings tendon and quadriceps tendon could be used as grafts. Some controversies still exist in these grafts. Due to little donor site complications, hamstrings tendon got more popular among Orthopedic surgeon. In PCL reconstruction, it is common to create tunnel in femoral and tibial sides, as so-called “femoral tunnel”and “tibial tunnel”. After creating tunnels, the grafts was passed and fixed. There are two turns in femoral and tibial sides, as so-called “femoral turn”and “tibial turn”. These two turns introduce some difficulties in PCL reconstruction and affect the stability and the healing of grafts. The “tibial turn”, or so-called “killer turn”was first proposed by Marc Friedman in an instructional course lecture at the meeting of the American Academy of Orthopaedic Surgeons. The tibial turn will cause increasing graft force or direct abrasion theoretically. Tibial inlay method was introduced by Dr. Berg for avoidance of this killer turn. But due to some inherent defects of tibial inlay method, tibial tunnel method plays a major role in PCL reconstruction. There are some variations in tibial tunnel method. In coronal plane, medial or lateral tunnel still remained in controversial. In saggital plane, 40 degree, 50 degree or 60 degree tunnel remained controversy. Clinically, it will depend on different opinion among Orthopaedists and surgical conditions. In contrast to ACL reconstruction, it is more important in consideration of graft force in PCL reconstruction. Because early rehabilitation will be advised in patients after PCL reconstruction, the graft force should be as less as possible before tendon –bone healing. Also comparing ACL reconstruction, tibial turn in PCL reconstruction will make affection on the graft. The pressure and strain should be as less as possible. To the best of our knowledge, there was no previous biomechanical study considering graft forces and pressure in tibial tunnel of PCL reconstruction. This will be a complete study in the tibial tunnels of PCL reconstruction! The results will provide a clear evidence base for an Orthopaedic surgeon to choose an adequate method in PCL reconstruction and postoperative rehabilitation program!
|Effective start/end date||8/1/10 → 7/31/11|