Author, year
KT-1000/2000
Posterior drawer (%)
Telos, and other comments
Ahn et al. 2005 [22]a
–
–
2.2 (0–7) vs. 2.9 (1–7) (p = ns)
Chan et al. 2006 [14]
0–2 in 50 %; 3–5 in 35 %; > 5 in 15 %
Grade I in 80
–
Chen and Gao, 2009 [3]
1.0 ± 1.0
Normal in 90;
Grade I in 5
–
Garofalo et al. 2006 [17]
–
Normal in 20;
Grade I in 67
–
Hermans et al. 2009 [5]
2.1 ± 1.6
Normal in 9;
Grade I in 68
–
Wong et al. 2009 [11]b
2.8 (1–6) vs. 3.3 (1–10) (p = ns)
–
–
Jung et al. 2004 [7]
1.8 ± 1.2
–
3.4 ± 2.4
64 % had
3 mm increased displacement
Kim et al. 2009 [24]c
–
–
3.6 ± 1.4 vs. 5.6 ± 2.0 (p < 0.03)
Lim et al. 2010 [32]
0–2 in 23 %; 3–5 in 68 %
–
–
MacGillivray et al. 2006 [15]d
5.9 vs. 5.5 (p = ns)
Grade I–II in 70
–
Seon and Song, 2006 [18]e
–
Grade I in 90 vs. 91
–
Wang et al. 2004 [10]f
2.3 (1–6) vs. 3.1 (0–7) (p = ns)
–
–
Wang et al. 2004 [9]g
3.2 (1–10) vs. 2.8 (1–6) (p = ns)
–
–
Wang et al. 2003 [20]
Normal in 52
–
Wu et al. 2007 [21]
0–2 in 46 %; 3–5 in 18 %
Grade I in 73
–
Zhao and Huangfu, 2007 [16]h
3.7 ± 1.6 vs. 1.7 ± 1.4 (p < 0.05)
Normal in 52 vs. 68
–
Zhao et al. 2008 [20]
< 3 mm in 94 %
Normal in 94
–
Jackson WF et al. 2008 [6]
1.1 ± 1.9
Normal in 36; grade I in 55
–
Deehan DJ et al. 200 [34]
< 2 in 74 %; 3–4 in 26 %
Normal in 50; grade I in 46
–
Shon OJ et al. 2010 [19]i
–
Normal–grade I in 93 vs. 94
3.0 ± 1.1 vs. 2.6 ± 0.5 (p = ns)
Yoon KH et al. 2011 [23]j
–
–
4.5 ± 2.3 vs. 3.1 ± 2.4 (p < 0.05)
Sekiya JK et al. 2005 [8]
< 3 mm in 62 %; 3–5 in 31 %
–
–
Adachi N et al. 2007 [13]
3.7 ± 2.4
–
3.5 ± 2.7
Table 28.2
Posterior knee laxity after PCL-based combined- and multiligament reconstruction
Author, year | KT-1000/2000 | Posterior drawer | Concomitant ligaments |
|---|---|---|---|
Lo et al. 2009 [26] | 2.6 (0–7) | Normal in 55 %; grade I in 45 % | Ligaments reconstructed included ACL and PCL in all 11 patients, PLC in 3 patients, and MCL repair in 4 patients |
Strobel et al. 2006 [29] | 2 (−4 to 7) | Grade I–II in 88 % | Ligaments reconstructed included ACL and PCL and PLC |
Zhao et al. 2006 [27] | 0–2 in 75%; 3–4 in 25% | – | Ligaments reconstructed included ACL and PCL |
Zhao et al. 2008 [28] | 0–2 in 16 patients (76 %); 3–5 in 4 patients; 6–10 in 1 patient | – | Ligaments reconstructed included ACL and PCL |
Fanelli and Edson, 2004 [25] | 2.0 (−2 to 7) | Normal in 70 %; grade I in 27 % | Ligaments reconstructed included PCL and PLC |
Khanduja et al. 2006 [30] | – | Normal in 37 %; grade I in 58 % | Ligaments reconstructed included PCL and PLC |
Range of Knee Motion
After isolated PCLR , limitation in range of knee motion was most commonly encountered during terminal flexion as opposed to terminal extension (Table 28.3). Approximately 10 % of patients undergoing PCLR were affected by some motion limitations [4, 6, 11, 12, 14, 16, 19, 21], but up to 20 % of patients had impaired motion in some reports [4, 17]. When present, knee flexion deficit was usually 5°–10° [3–5, 8, 12, 14, 16, 17, 19, 30], but was reported as high as 25° or more in rare cases [21, 22]. Nevertheless, functional impairment was minimal given the relatively minor loss in terminal flexion (5°–10°) and its minimal impact on activities of daily living and in sports that do not require deep bend or a squatting position. A loss of terminal knee extension was noticed in fewer studies [3, 6, 8, 12, 14, 16]. When reported, some indicated only “loss of hyperextension” but not lacking the ability to straighten the knee to 0° [12, 16]. Rarely did patients require manipulation under anesthesia (MUA) or lysis of adhesions after isolated PCLR (only 4–7 % of cases) [4, 5, 22, 23]. Similarly, with regard to lost range of motion, PCLR in the combined- or multiligament injured knee was generally related to terminal flexion rather than terminal extension (Table 28.4). Compared to isolated PCLR, loss of terminal knee flexion after PCL-based combined- or multiligament reconstruction was as twice as common, involving 12–24 % of the cases [26, 28, 29]. The amount of flexion deficit was also greater after PCL-based combined- or multiligament reconstruction compared to isolated PCLR, ranging between 10° and more than 25° [25, 26, 28, 29]. Severe stiffness that required MUA and lysis of adhesions after PCL-based combined- or multiligament reconstruction were also roughly twice as common as after isolated PCLR, affecting 7–11 % of patients [25, 26, 30]. Of note, in one series of combined PCL–ACL reconstructions, MUA was performed in 67 % of the cases [27]. Limitation in range of motion may be multifactorial. It could be related to tunnel location, amount of tension applied to the graft, knee angle during graft tensioning, other reconstructed ligaments, and arthrofibrosis related to early surgery. Moreover, limitation of knee motion may also be related to postoperative management guidelines such as duration of immobilization. In summary, the current literature suggests that lost terminal flexion is more common than loss of extension, but is relatively uncommon among patients who underwent isolated PCLR. PCL-based combined- or multiligament reconstructions, however, demonstrate lost flexion in more than 10 % of the patients and may be sufficient to necessitate an additional procedure aimed at restoration of motion. No differences in postoperative range of motion deficits are expected among different graft types, and between single- versus double-bundle PCLRs, but this lack of difference should be viewed in light of the very weak statistical power of such a comparison as a result of the small numbers of patients affected by loss of motion in these series [16, 19, 23, 24].
Table 28.3
Knee range of motion after isolated PCLR
Author, year | Flexion deficit n. of patients | Extension deficit n. of patients | MUA/adhesiolysis n. of patients | Comments |
|---|---|---|---|---|
Ahn et al. 2005 [22]a | 0 [0/18] vs. 1[1/18 = 6 %] | 0 [0/18] vs. 0 [0/18] | 0 [0/18] vs. 1 [1/18 = 6 %] | One patient in the Achilles group had ROM 0° –90° which required MUA + adhesiolysis |
Chan et al. 2006 [14] | 2 [2/20 = 10 %] | 1 [1/20 = 5 %] | 0 [0/20] | Flexion deficit was 3°–5°, whereas extension deficit was 16°–25° |
Chen and Gao, 2009 [3] | 2 [2/19 = 11%] | 1 [1/19= 5 %] | 0 [0/20] | Flexion deficit was 5°–10°, whereas extension deficit was 5° |
Garofalo et al. 2006 [17] | 4 [4/15 = 27 %] | 0 [0/15] | 0 [0/15] | Flexion deficit was 5°–10° |
Hermans et al. 2009 [5] | 8° ± 7° | 0 [0/22] | 1 [1/22 = 5 %] | Flexion deficit is presented as mean ± SD |
Wong et al. 2009 [11]b | – | – | – | NR |
Jung et al. 2004 [7] | – | – | – | NR |
Kim et al. 2009 [24]c | 4° ± 2 ° vs. 3° ± 1 ° (p = ns) | 0 [0/29] | 0 [0/29] | Flexion deficit is presented as side-to-side mean ± SD difference |
Lim et al. 2010 [32] | 0 [0/22] | 0 [0/22] | 0 [0/22] | |
MacGillivray et al. 2006 [15]d | – | – | – | NR |
Seon and Song, 2006 [18]e | – | – | – | NR |
Wang et al. 2004 [10]f | – | – | – | NR |
Wang et al. 2004 [9]g | – | – | – | NR |
Wang et al. 2003 [20] | – | – | – | NR |
Wu et al. 2007 [21] | 2 [2/22 = 9 %] | 2 [2/22 = 9%] | 0 [0/22] | Flexion deficit was 16°–25°, whereas extension deficit was 3°–10° |
Zhao and Huangfu, 2007 [16]h | 2 [2/21 = 10 %] vs. 1 [1/22 = 5 %] | 2 [2/21 = 10 %] vs. 1 [1/22= 5 %] | 0 [0/43] | Flexion deficit was 5°, whereas extension loss was described as “loss of 5° hyperextension” |
Zhao et al. 2008 [12] | 2 [2/18 = 11 %] | 1 [1/18 = 6 %] | 0 [0/18] | Flexion deficit was 5°, whereas extension loss was described as “loss of 5° hyperextension” |
Jackson WF et al. 2008 [6] | 2 [2/22 = 9 %] | 1 [1/22= 5 %] | 0 [0/22] | Flexion was above 5°, where extension deficit was above 3° |
Deehan DJ et al. 2003 [4] | 5 [5/24 = 21 %] | 0 [0/24] | 1 [1/24 = 4 %] | Flexion and extension deficits above 5° |
Shon OJ et al. 2010 [19]i | 1 [1/14 = 7 %]vs. 2 [2/16 = 13 %] | 0 [0/14] vs. 0 [0/16] | 0 [0/14] vs. 0 [0/16] | Flexion deficit was 10 |
Yoon KH et al. 2011 [23]j | See comments column | See comments column | 1 [1/25 = 4%] vs. 2 [2/28 = 7 %] | One [1/25 = 4 %] vs. two [2/28 = 7%] patients had ROM limitations, but direction and degree of limitation not reported |
Sekiya JK et al. 2005 [8] | 5° ± 5 ° [range, −1° to 18°] | 1° ± 3° [range, −6° to 5°] | 0 [0/14] | Only 14 of 21 [67 %] patients returned for follow-up examination |
Adachi N et al. 2007 [13] | – | – | – | NR |
Table 28.4
Knee range of motion after PCL-based combined- and multiligament reconstruction
