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Kinematics of the Posterior Cruciate Ligament/Posterolateral Corner–Injured Knee After Reconstruction by Single- and Double-Bundle Intra-articular Grafts

From the Walter A. Hoyt, Jr, Musculoskeletal Research Laboratory, Department of Orthopaedic Surgery, Summa Health System, Akron, Ohio

^* Address correspondence to Michael J. Askew, PhD, Hoyt Musculoskeletal Research Laboratory, Summa Health System, PO Box 2090, 444 North Main Street, Akron, OH 44309-2090 (e-mail: askewm{at}summa-health.org).

Background: Single- and double-bundle reconstructions have been proposed for the knee after combined posterior cruciate ligament/posterolateral corner injuries.

Hypothesis: The double-bundle posterior cruciate ligament reconstruction is superior to the single-bundle posterior cruciate ligament reconstruction with regard to restoration of normal knee kinematics to the posterior cruciate ligament/posterolateral corner–sectioned knee.

Study Design: Controlled laboratory study.

Methods: Kinematics of 8 fresh-frozen, cadaveric human knees were determined in the following conditions: intact, sectioned posterior cruciate ligament/posterolateral corner, single anterolateral bundle posterior cruciate reconstruction, and double-bundle posterior cruciate reconstruction.

Results: The sectioned knee demonstrated a posterior shift of the tibial neutral position and the abnormal posterior, varus, and external rotation laxities used clinically to define a combined posterior cruciate ligament/posterolateral corner injury. Both reconstructions restored the posterior laxity to levels that were not statistically different from those seen in the intact knee, but the double-bundle reconstruction more closely mimicked the posterior laxity profile of the intact knee, having statistically lower posterior laxities than did the single-bundle reconstruction at 30°, 60°, and 90° of flexion (P < .05, analysis of variance, HSD test). The resting position of the tibia after double-bundle reconstruction trended to be anteriorly subluxated relative to its position for the intact knee at flexion angles of 30° and greater (P <.05, paired t test). Neither technique corrected the abnormal varus or external rotation laxities.

Conclusion: With either single- or double-bundle reconstructions, additional posterolateral reconstruction is recommended to correct the external rotation laxity.

Clinical Relevance: Knowledge of the kinematics of the combined posterior cruciate ligament/posterolateral corner–injured knee is important in the proper diagnosis of the injury and in the selection of the appropriate surgical reconstruction.

Key Words: knee • posterior cruciate ligament (PCL) • reconstruction • in vitro • laxity • subluxation

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