Bicruciate lesion biomechanics, Part 2-treatment using a simultaneous tensioning protocol: ACL fixation first is better than PCL fixation first to restore tibiofemoral orientation

Author(s)

Franciozi, Carlos Eduardo ^{[1, 2, 3]} ; de Carvalho, Rogerio Teixeira ^{[1, 3]} ; Itami, Yasuo ^[4] ; McGarry, Michelle H. ^[5] ; McNeill Ingham, Sheila Jean ^{[6, 2, 3]} ; Abdalla, Rene Jorge ^{[2, 3]} ; Tibone, James Eugene ^[7] ; Lee, Thay Q. ^{[5, 8]}

Affiliation

^[1] Hosp Israelita Albert Einstein, Sao Paulo, SP - Brazil

^[2] Hosp Coracao HCor, Knee Inst, Sao Paulo, SP - Brazil

^[3] Univ Fed Sao Paulo, Dept Orthopaed & Traumatol, Escola Paulista Med, Rua Borges Lagoa 783, 5th Floor, BR-04038032 Sao Paulo, SP - Brazil

^[4] Osaka Med Coll, Dept Orthoped Surg, Takatsuki, Osaka - Japan

^[5] Long Beach VA Healthcare Syst, Orthopaed Biomech Lab, Long Beach, CA - USA

^[6] AACD, Sao Paulo, SP - Brazil

^[7] Univ Southern Calif, Keck Sch Med, Dept Orthopaed Surg, Los Angeles, CA 90033 - USA

^[8] Univ Calif Irvine, Dept Orthopaed Surg, Irvine, CA - USA

• Document type: Journal article
• Source: KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY; v. 27, n. 9, p. 2936-2944, SEP 2019.
• Web of Science Citations: 1

Abstract

Purpose An uncommon technique for bicruciate ligament reconstruction involving simultaneous tensioning of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) grafts with ACL graft fixation first has been pointed out as superior to the ``gold-standard{''} PCL graft fixation first. The purpose of this study was to compare tibiofemoral biomechanics between ACL fixation first and PCL fixation first in a simultaneous tensioning protocol for bicruciate ligament reconstruction. Methods 12 fresh-frozen cadaveric knees (six matched pairs) were tested using a custom testing system. Neutral tibial position representing tibiofemoral orientation, anterior-posterior (AP) tibial translation, varus-valgus laxity, and internal-external rotation were measured using a Microscribe 3DLX at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion. The following knee conditions were evaluated: intact, bicruciate deficient and following bicruciate reconstruction. A simultaneous tensioning protocol was used for bicruciate reconstruction and PCL fixation first was compared to ACL fixation first. PCL graft fixation was always performed at 90 degrees of flexion and ACL graft fixation was always performed at full extension. Results ACL fixation first achieved a tibiofemoral orientation closer to the intact knee than PCL fixation first at 90 degrees flexion (1.8 +/- 1.6 mm versus 6.1 +/- 3.2 mm, p = 0.016). PCL fixation first had a larger decrease in AP translation than ACL fixation first at 30 degrees flexion (64.6 +/- 3.5% vs. 58.3 +/- 2.4%, p = 0.01). No significant differences were found for varus/valgus, external-internal rotation decrements after bicruciate reconstruction nor for AP translation, varus/valgus and internal/external rotation increase after bicruciate lesion comparing ACL fixation first to PCL fixation first. Conclusion Bicruciate ligament reconstruction using a simultaneous tensioning protocol with ACL fixation first resulted in a closer to normal tibiofemoral orientation. This study will help guide surgeons in decision making for the graft tensioning protocol and fixation sequence in a bicruciate ligament reconstruction. (AU)

• FAPESP's process: 15/10317-7 - Bi cruciate knee lesion evaluation
• Grantee: Rene Jorge Abdalla
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/08952-6 - Osteochondral lesions treatment with parylene
• Grantee: CARLOS EDUARDO DA SILVEIRA FRANCIOZI
• Support Opportunities: Scholarships abroad - Research