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J Knee Surg
DOI: 10.1055/a-2542-2417
Original Article

Posterior Cruciate Ligament Revision Surgery: Outcomes, Failure Rates, and Complications: A Systematic Review of the Literature

Riccardo D'Ambrosi 
1   IRCCS Ospedale Galeazzi–Sant'Ambrogio, Milan, Italy
2   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
,
Alessandro Carrozzo
3   Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
,
Fabrizio Di Feo
1   IRCCS Ospedale Galeazzi–Sant'Ambrogio, Milan, Italy
,
Edna Skopljak
4   Department of Orthopedic Surgery, University Medical Centre, Ljubljana, Slovenia
5   Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
,
Srinivas B. S. Kambhampati
6   Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, India
,
Manish Attri
7   Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
,
Amit Meena
8   Department of Orthopaedics, Shalby Hospital, Jaipur, India
› Institutsangaben Funding None.
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Abstract

To synthesize and qualitatively assess the currently available evidence in the literature regarding the revision of posterior cruciate ligament (PCL) reconstruction. A systematic review was conducted on the basis of the preferred reporting items for systematic reviews and meta-analyses guidelines. The outcome data extracted from the studies were the Lysholm score, Orthopadische Arbeitsgruppe Knie (OAK) scoring system, KT-2000, International Knee Documentation Committee (IKDC) subjective and objective, radiological changes, rate of return to sports, complications, and failures and/or revision surgeries. The cohort consisted of 54 patients (42 [77.8%] men and 12 [22.2%] women), with a mean age of 33.14 ± 3.67 years (range: 17–48 years). The mean postoperative follow-up was 71.8 ± 45.32 months, whereas the mean time from primary surgery to revision was 41.7 ± 4.5 months. All studies reported a clinical improvement from preoperative to final follow-up in terms of the Lysholm, OAK, KT-2000, and IKDC scores (p < 0.05). Posterior displacement was significantly improved in all studies, demonstrating the stability of the knee. The mean posterior displacement ranged from a preoperative value of 10.68 ± 0.7 mm to a final value of 2.7 ± 0.2 mm (p < 0.05). A total of two (3.7%) failures were reported, and there were also eight (14.8%) revision surgeries. Studies on PCL reconstruction revisions have shown satisfactory clinical outcomes and a high level of knee stability, with minimal risk of new reruptures. However, the rate of returning to preinjury sports activity is relatively low. Whenever possible, it is recommended to perform the ligament revision in a single stage. The level of evidence is a systematic review of level IV.

Keywords

posterior cruciate ligament - revision surgery - sports medicine - arthroscopy

Registration

PROSPERO—CRD42024575858—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=575858.


Authors Contributions

All authors contributed equally.




Publikationsverlauf

Eingereicht: 16. Dezember 2024

Angenommen: 18. Februar 2025

Accepted Manuscript online:
20. Februar 2025

Artikel online veröffentlicht:
01. April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Pache S, Aman ZS, Kennedy M. et al. Posterior cruciate ligament: current concepts review. Arch Bone Jt Surg 2018; 6 (01) 8-18
    Suche in Google Scholar
  • 2 O'Donoghue DH. Surgical treatment of fresh injuries to the major ligaments of the knee. 1950. Clin Orthop Relat Res 2007; 454 (454) 23-26 , discussion 14
    Suche in Google Scholar
  • 3 Lee YS, Jung YB. Posterior cruciate ligament: focus on conflicting issues. Clin Orthop Surg 2013; 5 (04) 256-262
    Suche in Google Scholar
  • 4 Shelbourne KD, Benner RW, Ringenberg JD, Gray T. Optimal management of posterior cruciate ligament injuries: current perspectives. Orthop Res Rev 2017; 9: 13-22
    Suche in Google Scholar
  • 5 Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 2002; 18 (06) 603-612
    Suche in Google Scholar
  • 6 Harner CD, Fu FH, Irrgang JJ, Vogrin TM. Anterior and posterior cruciate ligament reconstruction in the new millennium: a global perspective. Knee Surg Sports Traumatol Arthrosc 2001; 9 (06) 330-336
    Suche in Google Scholar
  • 7 Wang CJ, Chen HS, Huang TW, Yuan LJ. Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee. Injury 2002; 33 (09) 815-821
    Suche in Google Scholar
  • 8 Gill GK, Gwathmey FW. Revision PCL reconstruction review/update. Curr Rev Musculoskelet Med 2018; 11 (02) 320-324
    Suche in Google Scholar
  • 9 D'Ambrosi R, Hallé A, Hardy A. Good clinical and radiological results following remnant-preserving posterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31 (06) 2418-2432
    Suche in Google Scholar
  • 10 Winkler PW, Zsidai B, Wagala NN. et al. Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29 (03) 682-693
    Suche in Google Scholar
  • 11 Fanelli GC, Fanelli MG, Fanelli DG. Revision posterior cruciate ligament surgery. Sports Med Arthrosc Rev 2017; 25 (01) 30-35
    Suche in Google Scholar
  • 12 D'Ambrosi R, Farinelli L, Kambhampati SBS. et al. Low rate of growth disturbance after posterior cruciate ligament reconstruction or repair in skeletally immature patients: A systematic review. J ISAKOS 2024;
    Suche in Google Scholar
  • 13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
    Suche in Google Scholar
  • 14 Posso M, Sala M. PROSPERO - reasons for its existence and why a systematic review and/or meta-analysis should be registered. Cir Esp (Engl Ed) 2024; 102 (07) 386-388
    Suche in Google Scholar
  • 15 Igelström E, Campbell M, Craig P, Katikireddi SV. Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: a methodological systematic review. J Clin Epidemiol 2021; 140: 22-32
    Suche in Google Scholar
  • 16 Cooper C, Booth A, Varley-Campbell J, Britten N, Garside R. Defining the process to literature searching in systematic reviews: a literature review of guidance and supporting studies. BMC Med Res Methodol 2018; 18 (01) 85
    Suche in Google Scholar
  • 17 Linares-Espinós E, Hernández V, Domínguez-Escrig JL. et al. Methodology of a systematic review. Actas Urol Esp (Engl Ed) 2018; 42 (08) 499-506
    Suche in Google Scholar
  • 18 Hohmann E, Feldman M, Hunt TJ, Cote MP, Brand JC. Research pearls: how do we establish the level of evidence?. Arthroscopy 2018; 34 (12) 3271-3277
    Suche in Google Scholar
  • 19 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    Suche in Google Scholar
  • 20 Chen YJ, Yang CP, Ho CS. et al. Midterm outcomes after revision posterior cruciate ligament reconstruction with a single-bundle transtibial autograft. Orthop J Sports Med 2022; 10 (08) 23 259671221115423
    Suche in Google Scholar
  • 21 Lee SH, Jung YB, Lee HJ, Jung HJ, Kim SH. Revision posterior cruciate ligament reconstruction using a modified tibial-inlay double-bundle technique. J Bone Joint Surg Am 2012; 94 (06) 516-522
    Suche in Google Scholar
  • 22 Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 2: results of revision using a 2-strand quadriceps tendon-patellar bone autograft. Am J Sports Med 2005; 33 (05) 655-665
    Suche in Google Scholar
  • 23 Li J, Kong F, Gao X, Shen Y, Gao S. Prospective randomized comparison of knee stability and proprioception for posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft. Arthroscopy 2016; 32 (12) 2548-2555
    Suche in Google Scholar
  • 24 Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med 2005; 33 (05) 646-654
    Suche in Google Scholar
  • 25 Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. Am J Sports Med 2013; 41 (01) 35-42
    Suche in Google Scholar
  • 26 Saddler SC, Noyes FR, Grood ES, Knochenmuss DR, Hefzy MS. Posterior cruciate ligament anatomy and length-tension behavior of PCL surface fibers. Am J Knee Surg 1996; 9 (04) 194-199
    Suche in Google Scholar
  • 27 Mejia EA, Noyes FR, Grood ES. Posterior cruciate ligament femoral insertion site characteristics. Importance for reconstructive procedures. Am J Sports Med 2002; 30 (05) 643-651
    Suche in Google Scholar
  • 28 Song EK, Park HW, Ahn YS, Seon JK. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med 2014; 42 (12) 2964-2971
    Suche in Google Scholar
  • 29 Bergfeld JA, Graham SM, Parker RD, Valdevit AD, Kambic HE. A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques. Am J Sports Med 2005; 33 (07) 976-981
    Suche in Google Scholar
  • 30 Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am 2002; 84 (06) 938-944
    Suche in Google Scholar
  • 31 Shin YS, Kim HJ, Lee DH. No clinically important difference in knee scores or instability between transtibial and inlay techniques for PCL reconstruction: a systematic review. Clin Orthop Relat Res 2017; 475 (04) 1239-1248
    Suche in Google Scholar
  • 32 Spiridonov SI, Slinkard NJ, LaPrade RF. Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J Bone Joint Surg Am 2011; 93 (19) 1773-1780
    Suche in Google Scholar
  • 33 Johnson P, Mitchell SM, Görtz S. Graft considerations in posterior cruciate ligament reconstruction. Curr Rev Musculoskelet Med 2018; 11 (03) 521-527
    Suche in Google Scholar
  • 34 Zawodny SR, Miller MD. Complications of posterior cruciate ligament surgery. Sports Med Arthrosc Rev 2010; 18 (04) 269-274
    Suche in Google Scholar
  • 35 Owesen C, Sandven-Thrane S, Lind M, Forssblad M, Granan LP, Årøen A. Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2384-2391
    Suche in Google Scholar
  • 36 Longo UG, Viganò M, Candela V. et al. Epidemiology of posterior cruciate ligament reconstructions in Italy: a 15-year study. J Clin Med 2021; 10 (03) 499
    Suche in Google Scholar