PDF herunterladen
J Knee Surg 2010; 23(1): 037-044
DOI: 10.1055/s-0030-1262321
© Thieme Medical Publishers

Evaluation of a Schanz Pin Technique for Posterior Cruciate Ligament Tensioning during Reconstruction

Erik Wetter1 , Terence McIff1 , Vincent Key1
  • 1Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. Juli 2010 (online)

    Lizenzen und Reprints

ABSTRACT

Maximum anterior positioning of the tibia relative to the femur during posterior cruciate ligament (PCL) reconstruction is essential for achieving a tight graft and stable joint. A Schanz pin inserted in the proximal tibia is sometimes used to pull the proximal tibia forward during tensioning of the graft in PCL reconstruction. This study was designed to evaluate whether this technique provides more anterior translation than the traditional anterior drawer technique. Eight fresh-frozen cadaveric knees were tested using both methods in randomized order: pulling anteriorly on a 5-mm Schanz pin in the proximal tibia or a leather strap behind the calf designed to simulate a surgeon's hand performing an anterior drawer maneuver. An anteriorly directed force was applied from 0 to 60 N, and the sagittal position of the tibia in relation to the femur was recorded using a mini C-arm. Tests were performed first on the intact knees, again after the PCL had been cut, and again following transection of the popliteal-fibular ligament. We found a statistically significant (p < 0.05) increase in tibial translation, ranging between 1 and 2 mm, when the tibia was pulled by the Schanz pin compared with the strap under every set of conditions. This greater anterior translation could improve the stability of the postreconstructed knee.

KEYWORDS

Posterior cruciate - graft tensioning - Schanz Screw - tibia - anterior drawer - ligament reconstruction

REFERENCES

  • 1 Sekiya J K, West R V, Ong B C, Irrgang J J, Fu F H, Harner C D. Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction.  Arthroscopy. 2005;  21 1042-1050
    CrossrefPubMedGoogle Scholar
  • 2 Wang C J, Chen H S, Huang T W, Yuan L J. Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee.  Injury. 2002;  33 815-821
    CrossrefPubMedGoogle Scholar
  • 3 McAllister D R, Markolf K L, Oakes D A, Young C R, McWilliams J. A biomechanical comparison of tibial inlay and tibial tunnel posterior cruciate ligament reconstruction techniques: graft pretension and knee laxity.  Am J Sports Med. 2002;  30 312-317
    CrossrefPubMedGoogle Scholar
  • 4 Garofalo R, Jolles B M, Moretti B, Siegrist O. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years' follow-up.  Arthroscopy. 2006;  22 1331-1338, e1
    CrossrefPubMedGoogle Scholar
  • 5 Seon J K, Song E K. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques.  Arthroscopy. 2006;  22 27-32
    CrossrefPubMedGoogle Scholar
  • 6 Fanelli G C, Edson C J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up.  Arthroscopy. 2002;  18 703-714
    Google Scholar
  • 7 MacDonald P, Miniaci A, Fowler P, Marks P, Finlay B. A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee.  Knee Surg Sports Traumatol Arthrosc. 1996;  3 252-255
    CrossrefPubMedGoogle Scholar
  • 8 Cross M J, Powell J F. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases.  Am J Sports Med. 1984;  12 292-297
    CrossrefPubMedGoogle Scholar
  • 9 Parolie J M, Bergfeld J A. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete.  Am J Sports Med. 1986;  14 35-38
    CrossrefPubMedGoogle Scholar
  • 10 Ittivej K, Prompaet S, Rojanasthien S. Factors influencing the treatment of posterior cruciate ligament injury.  J Med Assoc Thai. 2005;  88(Suppl 5) S84-S88
    PubMedGoogle Scholar
  • 11 Chen C H, Chen W J, Shih C H. Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: a double fixation method.  J Trauma. 2002;  52 938-945
    CrossrefPubMedGoogle Scholar
  • 12 Stannard J P, Riley R S, Sheils T M, McGwin Jr G, Volgas D A. Anatomic reconstruction of the posterior cruciate ligament after multiligament knee injuries. A combination of the tibial-inlay and two-femoral-tunnel techniques.  Am J Sports Med. 2003;  31 196-202
    CrossrefPubMedGoogle Scholar
  • 13 Wiley W B, Askew M J, Melby III A, Noe D A. Kinematics of the posterior cruciate ligament/posterolateral corner-injured knee after reconstruction by single- and double-bundle intra-articular grafts.  Am J Sports Med. 2006;  34 741-748
    CrossrefPubMedGoogle Scholar
  • 14 Berg E E. Posterior cruciate ligament tibial inlay reconstruction.  Arthroscopy. 1995;  11 69-76
    CrossrefPubMedGoogle Scholar
  • 15 Fanelli G C, Edson C J. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up.  Arthroscopy. 2004;  20 339-345
    CrossrefPubMedGoogle Scholar
  • 16 Keller P M, Shelbourne K D, McCarroll J R, Rettig A C. Nonoperatively treated isolated posterior cruciate ligament injuries.  Am J Sports Med. 1993;  21 132-136
    CrossrefPubMedGoogle Scholar
  • 17 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes.  Am J Sports Med. 1987;  15 553-557
    CrossrefPubMedGoogle Scholar
  • 18 Clancy W G, Dison L J. Double tunnel technique for reconstruction of the posterior cruciate ligament.  Oper Tech Sports Med. 1999;  7 110-117
    CrossrefPubMedGoogle Scholar
  • 19 Chen C H, Chen W J, Shih C H. Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft.  Arthroscopy. 2002;  18 603-612
    CrossrefPubMedGoogle Scholar
  • 20 Khanduja V, Somayaji H S, Harnett P, Utukuri M, Dowd G SE. Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency. A two- to nine-year follow-up study.  J Bone Joint Surg Br. 2006;  88 1169-1172
    CrossrefPubMedGoogle Scholar
  • 21 Deehan D J, Salmon L J, Russell V J, Pinczewski L A. Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up.  Arthroscopy. 2003;  19 955-962
    CrossrefPubMedGoogle Scholar
  • 22 Clancy Jr W G, Shelbourne K D, Zoellner G B, Keene J S, Reider B, Rosenberg T D. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure.  J Bone Joint Surg Am. 1983;  65 310-322
    PubMedGoogle Scholar
  • 23 Logan M, Williams A, Lavelle J, Gedroyc W, Freeman M. The effect of posterior cruciate ligament deficiency on knee kinematics.  Am J Sports Med. 2004;  32 1915-1922
    CrossrefPubMedGoogle Scholar
  • 24 Boynton M D, Tietjens B R. Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee.  Am J Sports Med. 1996;  24 306-310
    CrossrefPubMedGoogle Scholar
  • 25 Geissler W B, Whipple T L. Intraarticular abnormalities in association with posterior cruciate ligament injuries.  Am J Sports Med. 1993;  21 846-849
    CrossrefPubMedGoogle Scholar
  • 26 Shelbourne K D, Davis T J, Patel D V. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study.  Am J Sports Med. 1999;  27 276-283
    CrossrefPubMedGoogle Scholar
  • 27 Harner C D, Höher J. Evaluation and treatment of posterior cruciate ligament injuries.  Am J Sports Med. 1998;  26 471-482
    PubMedGoogle Scholar
  • 28 Cooper D E, Stewart D. Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up.  Am J Sports Med. 2004;  32 346-360
    CrossrefPubMedGoogle Scholar
  • 29 Wang C J, Chen H S, Huang T W. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear.  Injury. 2003;  34 747-751
    CrossrefPubMedGoogle Scholar
  • 30 Hagemeister N, Duval N, Yahia L, Krudwig W, Witzel U, de Guise J A. Comparison of two methods for reconstruction of the posterior cruciate ligament using a computer based method: quantitative evaluation of laxity, three-dimensional kinematics and ligament deformation measurement in cadaver knees.  Knee. 2002;  9 291-299
    CrossrefPubMedGoogle Scholar
  • 31 Bergfeld J A, McAllister D R, Parker R D, Valdevit A DC, Kambic H E. A biomechanical comparison of posterior cruciate ligament reconstruction techniques.  Am J Sports Med. 2001;  29 129-136
    CrossrefPubMedGoogle Scholar
  • 32 Skyhar M J, Warren R F, Ortiz G J, Schwartz E, Otis J C. The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee.  J Bone Joint Surg Am. 1993;  75 694-699
    PubMedGoogle Scholar
  • 33 Strobel M J, Weiler A, Schulz M S, Russe K, Eichhorn H J. Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees.  Arthroscopy. 2003;  19 262-268
    CrossrefPubMedGoogle Scholar
  • 34 Covey C D, Sapega A A. Injuries of the posterior cruciate ligament.  J Bone Joint Surg Am. 1993;  75 1376-1386
    PubMedGoogle Scholar
  • 35 Chen C H, Chen W J, Shih C H, Chou S W. Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon autograft: minimal 3 years follow-up.  Am J Sports Med. 2004;  32 361-368
    CrossrefPubMedGoogle Scholar
  • 36 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: Part II.  Arthroscopy. 1995;  11 526-529
    CrossrefPubMedGoogle Scholar
  • 37 Shelbourne K D, Carr D R. Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment.  Instr Course Lect. 2003;  52 413-418
    PubMedGoogle Scholar
  • 38 Sidles J A, Clark J M, Garbini J L. A geometric theory of the equilibrium mechanics of fibers in ligaments and tendons.  J Biomech. 1991;  24 943-949
    CrossrefPubMedGoogle Scholar
  • 39 Miyasaka K C, Daniel D M, Stone M L, Hirshman P. The incidence of knee ligament injuries in the general population.  Am J Knee Surg. 1991;  4 3-8
    PubMedGoogle Scholar
  • 40 Gill T J, DeFrate L E, Wang C et al.. The effect of posterior cruciate ligament reconstruction on patellofemoral contact pressures in the knee joint under simulated muscle loads.  Am J Sports Med. 2004;  32 109-115
    CrossrefPubMedGoogle Scholar
  • 41 Bergfeld J A, Graham S M, Parker R D, Valdevit A DC, Kambic H E. A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques.  Am J Sports Med. 2005;  33 976-981
    CrossrefPubMedGoogle Scholar

Terence McIffM.B.A. Ph.D. 

Department of Orthopedic Surgery, University of Kansas Medical Center

3901 Rainbow Blvd., M.S. 3037, Kansas City, KS 66160

eMail: tmciff@kumc.edu