Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2022 Dec 8

PMID 36479468

Authors

Erik Therrien

Ayoosh Pareek

Bryant M Song

Ryan R Wilbur

Sara E Till

Aaron J Krych

Michael J Stuart

Bruce A Levy

Affiliations

Soon will be listed here.

Abstract

Background: Biomechanical studies support the use of suture tape reinforcement for limiting graft elongation and increasing strength in knee ligament reconstructions.

Purpose: To compare posterior cruciate ligament (PCL) laxity, complication and reoperation rates, and patient-reported outcomes (PROs) after all-inside single-bundle PCL reconstruction (PCLR) with versus without independent suture tape reinforcement.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective cohort study of consecutive patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement at a single academic institution from 2012 to 2019. Medical records were reviewed for patient characteristics, additional injuries, and concomitant procedures. PRO scores (including the International Knee Documentation Committee [IKDC], Tegner activity scale, and Lysholm scores), bilateral comparison kneeling radiographs, and physical examination findings were collected at a minimum of 2 years postoperatively.

Results: Included were 50 patients: 19 with suture tape reinforcement (mean age 30.6 ± 2.9 years) and 31 without suture tape reinforcement (control group; mean age 26.2 ± 1.6 years). One PCLR graft in the suture tape group failed. Posterior drawer examination revealed grade 1+ laxity in 4 of 19 (21%) of the suture tape cohort versus 6 of 31 (19%) of the control cohort ( > .999). Bilateral kneeling radiographs showed similar side-to-side differences in laxity between the groups (suture tape vs control: mean, 1.9 ± 0.4 vs 2.6 ± 0.6 mm; = .361). There were no statistically significant differences between the groups in postoperative IKDC (suture tape vs control: 79.3 vs 79.6; = .779), Lysholm (87.5 vs 84.3; = .828), or Tegner activity (5.6 vs 5.7; = .562) scores.

Conclusion: All-inside single-bundle PCLR with and without independent suture tape reinforcement demonstrated low rates of graft failure, complications, and reoperations, with satisfactory PROs at a minimum 2-year follow-up. Radiographic posterior tibial translation was comparable between the 2 groups.

Citing Articles

Outcomes After Posterior Cruciate Ligament Reconstruction With Suture Tape Augmentation and an Accelerated Rehabilitation Protocol: A Retrospective Cohort Study.

Paroneto A, Gomes P, Carrijo P, Cohen M, Ramos L Orthop J Sports Med. 2025; 13(2):23259671241308590.

PMID: 39926586 PMC: 11806459. DOI: 10.1177/23259671241308590.

Retrospective cohort study comparing postoperative joint stability between all-inside PCL reconstruction technique and conventional PCL reconstruction technique in patients with multiligament knee injury.

Buranapuntaruk T, Boonchaliaw N, Itthipanichpong T Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024; 38:9-13.

PMID: 39220631 PMC: 11362622. DOI: 10.1016/j.asmart.2024.07.001.

Arthroscopic Confirmation of Femoral Button Deployment During Posterior Cruciate Ligament Reconstruction.

Abed Ali A, Pettinari F, Alayane A, Barosso M, Osorio T, Vieira T Arthrosc Tech. 2024; 13(6):102978.

PMID: 39036411 PMC: 11258917. DOI: 10.1016/j.eats.2024.102978.

Tissue Augmentation Techniques in the Management of Ligamentous Knee Injuries.

Thompson A, Bolia I, Fathi A, Dobitsch A, Cruz C, Grewal R Orthop Res Rev. 2023; 15:215-223.

PMID: 38028655 PMC: 10657762. DOI: 10.2147/ORR.S385817.

References

Jackman T, LaPrade R, Pontinen T, Lender P . Intraobserver and interobserver reliability of the kneeling technique of stress radiography for the evaluation of posterior knee laxity. Am J Sports Med. 2008; 36(8):1571-6. DOI: 10.1177/0363546508315897. View

Briggs K, Lysholm J, Tegner Y, Rodkey W, Kocher M, Steadman J . The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009; 37(5):890-7. DOI: 10.1177/0363546508330143. View

Levy B, Piepenbrink M, Stuart M, Wijdicks C . Posterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement: An In Vitro Biomechanical Full Construct Study. Orthop J Sports Med. 2021; 9(2):2325967120981875. PMC: 7890739. DOI: 10.1177/2325967120981875. View

LaPrade R, Cinque M, Dornan G, DePhillipo N, Geeslin A, Moatshe G . Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years' Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions. Am J Sports Med. 2018; 46(8):1809-1818. DOI: 10.1177/0363546517750855. View

Milles J, Nuelle C, Pfeiffer F, Stannard J, Smith P, Kfuri Jr M . Biomechanical Comparison: Single-Bundle versus Double-Bundle Posterior Cruciate Ligament Reconstruction Techniques. J Knee Surg. 2016; 30(4):347-351. DOI: 10.1055/s-0036-1588014. View

Dugas J, Walters B, Beason D, Fleisig G, Chronister J . Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction. Am J Sports Med. 2016; 44(3):735-41. DOI: 10.1177/0363546515620390. View

Lubowitz J, Mackay G, Gilmer B . Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech. 2014; 3(4):e505-8. PMC: 4175550. DOI: 10.1016/j.eats.2014.05.008. View

Hopper G, Heusdens C, Dossche L, Mackay G . Posterior Cruciate Ligament Repair With Suture Tape Augmentation. Arthrosc Tech. 2019; 8(1):e7-e10. PMC: 6408582. DOI: 10.1016/j.eats.2018.08.022. View

Levy B, Fanelli G, Miller M, Stuart M . Advances in posterior cruciate ligament reconstruction. Instr Course Lect. 2015; 64:543-54. View

10.

Bachmaier S, Smith P, Bley J, Wijdicks C . Independent Suture Tape Reinforcement of Small and Standard Diameter Grafts for Anterior Cruciate Ligament Reconstruction: A Biomechanical Full Construct Model. Arthroscopy. 2017; 34(2):490-499. DOI: 10.1016/j.arthro.2017.10.037. View

11.

Shelbourne K, Davis T, Patel D . The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1999; 27(3):276-83. DOI: 10.1177/03635465990270030201. View

12.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P . Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001; 29(5):600-13. DOI: 10.1177/03635465010290051301. View

13.

Sanders T, Pareek A, Barrett I, Kremers H, Bryan A, Stuart M . Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc. 2016; 25(10):3017-3023. DOI: 10.1007/s00167-016-4052-y. View

14.

Boksh K, Haque A, Sharma A, Divall P, Singh H . Use of Suture Tapes Versus Conventional Sutures for Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis. Am J Sports Med. 2021; 50(1):264-272. DOI: 10.1177/0363546521998318. View

15.

Parkes C, Leland D, Levy B, Stuart M, Camp C, Saris D . Hamstring Autograft Anterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement. Arthroscopy. 2020; 37(2):609-616. PMC: 7867617. DOI: 10.1016/j.arthro.2020.09.002. View

16.

Hopper G, Irfan A, Jenkins J, Wilson W, Mackay G . Posterior cruciate ligament repair with suture tape augmentation: a case series with minimum 2-year follow-up. J Exp Orthop. 2021; 8(1):28. PMC: 8050190. DOI: 10.1186/s40634-021-00337-y. View

17.

Levy B, Dajani K, Whelan D, Stannard J, Fanelli G, Stuart M . Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009; 25(4):430-8. DOI: 10.1016/j.arthro.2009.01.008. View

18.

Shin Y, Kim H, Lee D . No Clinically Important Difference in Knee Scores or Instability Between Transtibial and Inlay Techniques for PCL Reconstruction: A Systematic Review. Clin Orthop Relat Res. 2016; 475(4):1239-1248. PMC: 5339144. DOI: 10.1007/s11999-016-5176-6. View

19.

Qi Y, Wang H, Wang S, Zhang Z, Huang A, Yu J . A systematic review of double-bundle versus single-bundle posterior cruciate ligament reconstruction. BMC Musculoskelet Disord. 2016; 17:45. PMC: 4730768. DOI: 10.1186/s12891-016-0896-z. View

20.

Gibbs D, Shin S . Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. Orthop J Sports Med. 2020; 8(7):2325967120935063. PMC: 7391447. DOI: 10.1177/2325967120935063. View