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Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation
Journal article   Peer reviewed

Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation

Aly M Fayed, Benjamin B Rothrauff, Darren de Sa, Freddie H Fu and Volker Musahl
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Vol.29(4), pp.1238-1250
04/2021
DOI: 10.1007/s00167-020-06171-6
PMID: 32705296

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Abstract

In single-stage ACL-PCL reconstruction, there is uncertainty regarding the order of graft tensioning and fixation, as well as the optimal knee flexion angle(s) for graft fixation. A systematic review of clinical studies of single-stage combined ACL-PCL reconstruction was performed to determine whether a particular fixation sequence and/or knee flexion angle is associated with superior outcomes. A systematic review was performed according to PRISMA guidelines. All levels of evidence were included. All outcome measures were extracted, including physical examination values, radiographic measurements, and objective and subjective outcomes. Of the 19 included studies, 17 tensioned and fixed the PCL before the ACL. Only four studies reported the methods/forces used for graft tensioning. Across studies, the ACL was fixed at variable knee flexion angles, from full extension to 70°. Conversely, 3 studies fixed the PCL at a knee flexion angle < 45°, while the remaining 16 studies fixed the PCL at a flexion angle > 70°. Patient-reported outcomes were qualitatively similar between groups. This systematic review found considerable variability in graft tension, fixation sequence, and knee flexion angle at the time of fixation, with insufficient evidence to support specific surgical practices. Most commonly, the PCL is fixed before the ACL graft, with fixation occurring at a knee flexion angle between 70° and 90° and near full extension, respectively. The methodology for quantifying the forces applied for graft tensioning is rarely described. Given this clinical equipoise, future studies should consistently report these surgical details. Furthermore, prospective, randomized studies on the treatment of multiligament knee injuries are needed to improve outcomes in patients. IV.
 Anterior Cruciate Ligament Injuries - physiopathology Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Arthroscopy - methods Biomechanical Phenomena Humans Knee - anatomy & histology Patient Positioning - methods Posterior Cruciate Ligament - injuries Posterior Cruciate Ligament - physiopathology Posterior Cruciate Ligament - surgery Posterior Cruciate Ligament Reconstruction - methods Range of Motion, Articular

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