Serial magnetic resonance imaging study of posterior cruciate ligament reconstruction or augmentation using hamstring tendons

Abstract Purpose The purpose of this study was to analyze serial changes in the magnetic resonance imaging (MRI) signals of autograft hamstrings single bundle posterior cruciate ligament (PCL) reconstruction and the effects of remnant preservation (augmentation). Material and methods Twenty-two isol...

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Published in:	Orthopaedics & traumatology, surgery & research Vol. 100; no. 7; pp. 755 - 760
Main Authors:	Fujimoto, E, Sasashige, Y, Masuda, Y, Tsuchida, Y, Hisatome, T, Kashiwagi, K, Sasaki, H, Touten, Y, Kazusa, H, Eguchi, A, Nagata, Y
Format:	Journal Article
Language:	English
Published:	France Elsevier Masson SAS 01-11-2014
Subjects:	Adolescent Adult Arthroscopy - methods Augmentation Female Follow-Up Studies Hamstring tendon Humans Joint Instability - diagnosis Joint Instability - etiology Joint Instability - surgery Knee Injuries - complications Knee Injuries - diagnosis Knee Injuries - surgery Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Middle Aged Orthopedics Posterior Cruciate Ligament - injuries Posterior Cruciate Ligament - pathology Posterior Cruciate Ligament - surgery Posterior cruciate ligament reconstruction Reconstructive Surgical Procedures - methods Remnant preservation Retrospective Studies Surgery Tendons - transplantation Time Factors Transplantation, Autologous Trauma Severity Indices Young Adult Augmentation Posterior cruciate ligament reconstruction Magnetic resonance imaging Remnant preservation Hamstring tendon
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Summary:	Abstract Purpose The purpose of this study was to analyze serial changes in the magnetic resonance imaging (MRI) signals of autograft hamstrings single bundle posterior cruciate ligament (PCL) reconstruction and the effects of remnant preservation (augmentation). Material and methods Twenty-two isolated PCL injuries were arthroscopically reconstructed or augmented with hamstring tendons. MRI scans were obtained at 3, 6, and 12 months, and prior to the second-look arthroscopy (average 20.7 months). The patients were divided into 2 groups by remnant preservation: five PCL reconstructions after PCL remnant resection (Group Rec) (23%), and 17 reconstructions preserving the remnant (Group Aug) (77%). The 22 patients were also divided in two groups depending on the location of the PCL tear. There were 9 knees with proximal tear (Type P) (41%) and 13 knees with distal tear (Type D) (59%). The signal intensity and fiber continuity of 4 zones (proximal, middle, distal intra-articular and tibial tunnel zones) were evaluated by the Mariani score. Results The average MRI evaluation score gradually increased from 6 months through the final MRI. The intra-articular part of the graft exhibited slower maturation (12 months – final scan) as compared with the tibial tunnel (6–12 months). The distal zone underwent better maturation than the proximal or middle zones at all points. In the proximal zone, the score for Group Aug was significantly higher than Group Rec. In the proximal zone, the Type D score with a proximally-preserved remnant was significantly higher than Type P without a proximal remnant. Conclusions The hamstring tendons require more than 1 year to achieve low-signal intensity. PCL remnant has a beneficial effect on the maturation of the hamstring graft. Level of evidence IV: therapeutic case series.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1877-0568 1877-0568
DOI:	10.1016/j.otsr.2014.06.018