Robert LaPrade, MD, PhD Recently Participated in a Two-Part Study on the Posterior Cruciate Ligament Published by the American Orthopaedic Society for Sports Medicine

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Until the past 5-10 years, the results of PCL reconstructions were not as favorable as ACL reconstructions and many surgeons abandoned PCL reconstruction surgery. Recent advances on defining the anatomy, biomechanics and now the proper tensioning techniques for PCL reconstructions have greatly improved the results and outcomes for PCL tears.

Robert LaPrade, MD, PhD. (left) together with Lars Engebretsen, MD (right)

Colorado knee specialist Robert LaPrade, MD, PhD and his team at the Steadman Philippon Research Institute partnered together with Lars Engebretsen, MD from the Oslo Sports Trauma Research Center in Norway to complete the study Posterior Cruciate Ligament Graft Fixation Angles: Biomechanical Evaluation for Single – and Double-Bundle Reconstruction (Part 1 and Part 2). The researchers on this study were awarded the American Orthopaedic Society for Sports Medicine (AOSSM) Excellence in Research Award. This award is given to the best paper submitted in any category and was presented by Nicholas Kennedy at the AOSSM.

The posterior cruciate ligament (PCL) is the largest intra-articular ligament in the knee joint. As the strongest ligament in the knee it is injured less often, accounting for 3-37% of all knee injuries. Typically, PCL tears are caused by a powerful force and in many cases from sports trauma.

Currently, there is no consensus existing for the optimal graft fixation angle for a PCL reconstruction. These two studies investigate alternative graft fixation angles and the resultant graft forces to optimize the stabilization of PCL reconstruction without over-constraining the knee.

In part one of this study, single-bundle (SB) PCL reconstruction (PCLR) is evaluated for the optimal graft fixations angles and direct graft forces. In part two of this study, the double-bundle (DB) PCL reconstruction (PCLR) is evaluated for optimal graft fixation angles and direct graft forces. Less-than optimal graft fixation angles can potentially introduce either overconstraint, which may limit the joint’s range of motion and predispose the graft to premature failure, or underconstraint, which may lead to residual laxity.

Single-bundle (SB) PCL reconstruction (PCLR) remains the most commonly implemented intraoperative PCLR technique used today. In part one of this controlled study nine fresh-frozen human cadaveric knees were biomechanically evaluated. The result of this study suggests that SB PCL graft fixation angles of 75˚, 90˚, and 105˚ were comparable in restoring knee kinematics and exposed the graft to similar time-zero loads. However, SB PCLR did not fully reduce knee laxity to the intact state.

Prior studies have suggested that double-bundle (DB) PCL reconstruction (PCLR) reduces residual laxity compared with the intact state better than SB PCLR. Although, few studies have compared commonly used graft fixation angles and the influences that graft fixation angles have on overall graft forces and knee laxity. In part two of this controlled study, nine match-paired, fresh-frozen human cadaveric knees were biomechanically evaluated. The results of the study found that all 6 fixation angles combinations significantly improved knee kinematics compared with the sectioned state at time zero.

About Dr. LaPrade

Robert LaPrade MD, PhD is a Colorado complex knee specialist at The Steadman Clinic in Vail, Colorado. Contributing heavily to research, Dr. LaPrade serves as the Chief Medical Officer, Co-Director of Sports Medicine Fellowship Program and Director of the International Research Scholar Program at the Steadman Philippon Research Institute. Dr. LaPrade specializes in posterolateral knee (PLC), PCL tears, revision of ACL reconstructions, meniscal transplants and all complex knee injuries.

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