Posterior Cruciate Ligament Injuries

Posterior Cruciate Ligament Injuries

Springer Science+Business Media, LLC

Gregory C. Fanelli, MD Chief, Sports Injury Clinic and Arthroscopic Surgery Geisinger Medical Center Danville, Pennsylvania Editor Posterior Cruciate Ligament Injuries A Practical Guide to Management With a Foreword by M. Mike Malek, MD, FACS With Illustrations by Joel Herring With 234 Illustrations, 31 in Full Color Springer

Gregory C. Fanelli, MD Chief, Sports Injury Clinic and Arthroscopic Surgery Geisinger Medical Center Danville, PA 17822-2130 USA Library of Congress Cataloging-in-Publication Data Posterior cruciate ligament injuries : a practical guide to management I editor, Gregory C. Fanelli p.; em. Includes bibliographical references and index. ISBN 978-1-4757-6216-7 ISBN 978-0-387-21601-0 (ebook) DOI 10.1007/978-0-387-21601-0 1. Cruciate ligaments-wounds and injuries-treatment. 2. Knee-Wounds and injuries-treatment. 3. Knee-Surgery. I. Fanelli, Gregory C. [DNLM: 1. Posterior Cruciate Ligament-injuries. 2. Knee Injuries-therapy. 3. Posterior Cruciate Ligament-surgery. 4. Tendon Injuries-therapy. WE 870 P857 2000] RD56l.P676 2000 617.5' 82044-dc21 99-046324 Printed on acid-free paper. 2001 Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 2001 Softcover reprint of the hardcover 1st edition 2001 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+ Business Media, LLC. except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Matrix Publishing Services, Inc., and managed by Terry Karnak; manufacturing supervised by Jeffrey Taub. Typeset by Matrix Publishing Services, Inc., York, PA. 9 8 7 6 5 4 3 2 1 ISBN 978-1-4757-6216-7 SPIN 10682854

To my wife Lori, and my children Matthew, David, and Megan whose love, support, and patience have been unwavering during this project.

Foreword In the 1980s and 1990s several excellent volumes were published dealing with the pathology, recognition, and treatment of anterior cruciate ligament injuries. The idea of treating anterior cruciate ligament injuries nonoperatively changed to aggressive surgical treatment of anterior cruciate-deficient knees in the belief that this provides the best chance for a normal functioning knee, preventing damage to the secondary restraints and development of osteoarthritis. However, this concept has been challenged by many and the controversy continues. As the new millennium starts we are focusing our attention on a new frontier-the posterior cruciate ligament. This is the strongest ligament in the knee, and yet it has been ignored for a long time. We seem to be revisiting the issues we faced with the anterior cruciate ligament in the 1970s and in the ensuing 25 years. Now we must learn how to manage and successfully treat injuries to the posterior cruciate ligament. Pioneers of sports medicine and ligament surgery such as O'Donaghue, Hughston, Slocum, Nicholas, Marshall, and others have taught us the principles of knee function and biomechanics, and the basics of ligament surgery. It is up to the younger generation of surgeons and scientists to continue in the footsteps of these men and provide us with a follow-up to the work done by them. I am pleased that Dr. Fanelli has brought together an outstanding group of contributors, compiled an excellent volume on posterior cruciate ligament injuries, and provided a practical guide for management of these injuries. In this volume, anatomy and biomechanics of the posterior cruciate ligament and the posterolateral corner are well defined. Clinical examination of the posterior cruciate deficient knee as well as diagnostic testing is clearly described. Nonoperative and operative treatment is discussed, including the latest methods of surgical reconstruction. Sections are devoted to rehabilitation as well as complications of posterior cruciate ligament surgery. The authors are the pioneers of our time, and their devotion to this subject is clear. I am greatly honored to have been asked to provide the Foreword to such an outstanding collection of material on injuries of the posterior cruciate ligament. M. Mike Malek, MD, FACS Washington Orthopaedic & Knee Clinic, Inc. Viena, Virginia

Preface The pathways that our individual orthopaedic careers take are largely determined by our practice environment. It has been my good fortune to be in a position that enabled me to expand my research interests and surgical techniques in the assessment and treatment of posterior cruciate ligament (PCL) and related injuries. I believe the same situation exists for the other contributors to this book. We all share a passion and a commitment to the treatment of complex instabilities about the knee involving the PCL. The purpose of this book is to share our knowledge and experience in the assessment and treatment of the PCL and related injuries. It is my personal hope that this book will serve as a launch pad for new ideas to further develop treatment plans and surgical techniques for PCL injuries. Acknowledgments Many people have influenced my career, and subsequently the development of this book. M. Mike Malek, M.D., with whom I did my fellowship, has been a mentor, a great friend, and an example for the pursuit of excellence in arthroscopic surgery. The faculty and residents in the Orthopaedic Surgery Department at Geisinger Medical Center all support the PCL research program: Craig J. Edson, M.S., P.T./A.T.C., friend, colleague, and research associate is an outstanding resource for our patients and myself and the operating room and clinic orthopaedic teams at Geisinger Medical Center, are the best orthopaedic support staff in the world. Their dedication and drive for excellence are unequaled. Arthrotek, Inc., a division of Biomet, Inc., contributed to the production of this book. Many of my colleagues have taken time out of their busy schedules to contribute chapters to this book. Mary Zubowicz, my secretary, has always been able to keep the most hectic schedules and deadlines organized and moving forward, all with a smile. Gregory C. Fanelli, MD Danville, Pennsylvania

Contents Foreword M. Mike Malek Preface Contributors VII lx Xlll PART 1: ANATOMY AND BIOMECHANICS 1. Anatomy and Biomechanics of the Posterior Cruciate Ligament 3 Christopher D. Harner, Tracy M. Vogrin, and Savio L.- Y. Woo 2. Anatomy and Biomechanics of the Posterolateral Aspect of the Knee 23 Robert F. LaPrade and Timothy S. Bollom 3. Anatomy and Biomechanics of the Posteromedial Aspect of the Knee 4 7 Fred Flandry and Christian C. Perry PART II: DIAGNOSIS AND EVALUATION 4. Clinical Examination of the Posterior Cruciate Ligament-Deficient Knee 65 Darren L. ] ohnson 5. Imaging of the Posterior Cruciate Ligament 77 D.C. Peterson, L.M.F. Thain, and P.J. Fowler 6. Measurement of the Posterior Cruciate Ligament and Posterolateral Corner 87 Don Johnson 7. Arthroscopic Evaluation of the Posterior Cruciate Ligament and Posterolateral Corner 95 Gregory C. Fanelli PART III: NONOPERATIVE TREATMENT 8. The Natural History of the Posterior Cruciate Ligament-Deficient Knee 109 Bradley F. Giannotti 9. Nonoperative Treatment of Posterior Cruciate Ligament Injuries 117 John A. Bergfeld, Manuel Leyes, and Gary]. Calabrese

Xll Contents PART IV: SURGICAL TREATMENT 10. Graft Selection in Posterior Cruciate Ligament Surgery 135 Walter R. Shelton 11. Arthroscopically Assisted Posterior Cruciate Ligament Reconstruction: Transtibial Tunnel Technique 141 Gregory C. Fanelli 12. Arthroscopically Assisted Posterior Cruciate Ligament Reconstruction: Tibial Inlay Technique 157 Richard D. Parker, John A. Bergfeld, David R. McAllister, and Gary ]. Calabrese 13. Arthroscopically Assisted Posterior Cruciate Ligament Reconstruction: Double Femoral Tunnel Technique 175 Michael H. Metcalf and Roger V. Larson 14. Cruciate Ligament Reconstruction with Synthetics 189 Don Johnson and J.P. Laboureau 15. Arthroscopically Assisted Combined Anterior Cruciate Ligament/Posterior Cruciate Ligament Reconstruction 215 Gregory C. Fanelli and Daniel D. Feldmann 16. Surgical Treatment of Posterolateral Instability 237 Roger V. Larson and Michael H. Metcalf 17. Surgical Treatment of Medial Ligament Injuries Associated with Posterior Cruciate Ligament Tears 249 Fred Flandry and Jack C. Hughston 18. Rehabilitation of Posterior Cruciate Ligament Injuries 267 Craig]. Edson and Daniel D. Feldmann 19. Complications in Posterior Cruciate Ligament Surgery 291 Gregory C. Fanelli and Timothy ]. Monahan Index 303

Contributors John A. Bergfeld, MD Section of Sports Medicine Department of Orthopaedics The Cleveland Clinic Foundation Cleveland, OH 44131-2143, USA Timothy S. Bollom, MD Sports Medicine and Shoulder Divisions University of Minnesota Minneapolis, MN 55455-0100, USA Gary ]. Calabrese, PT Sports Orthopaedic Rehabilitation Section of Sports Medicine Department of Orthopaedics The Cleveland Clinic Foundation Cleveland, OH 44131-2143, USA Craig ]. Edson, MHS, PT, ATC PennState Geisinger Center for Rehabilitation An Affiliate of State HealthSouth Danville, PA 17822-2130, USA Gregory C. Fanelli, MD Sports Injury Clinic and Arthroscopic Surgery Geisinger Medical Center Danville, PA 17822-2130, USA Daniel D. Feldmann, MD Geisinger Medical Center Danville, PA 17822-2130, USA Fred Flandry, MD, FACS The Hughston Clinic Tulane University School of Medicine Columbus, GA 31908, USA P.J. Fowler, MD, FRCS (C) University of Western Ontario London Health Sciences Centre Fowler Kennedy Sport Medicine Clinic London, ON N6A 3K7, Canada Bradley F. Giannotti, MD Charles Cole Memorial Hospital Department of Orthopaedics and Sports Medicine Coudersport, PA 16915, USA Christopher D. Harner, MD University of Pittsburgh Musculoskeletal Research Center Pittsburgh, PA 15213, USA Jack C. Hughston, MD The Hughston Clinic Columbus, GA 31908, USA Darren L. Johnson, MD Section of Sports Medicine University of Kentucky School of Medicine Lexington, KY 40536, USA Don Johnson, MD University of Ottawa Sports Medicine Clinic Carleton University Ottawa, ON K1N 6N5, Canada J.P. Laboureau, MD Orthopaedic and Sports Medicine Center Chenove 21300, France

XlV Contributors Robert F. LaPrade, MD Sports Medicine and Shoulder Services University of Minnesota Minneapolis, MN 55455, USA Roger V. Larson, MD University of Washington Seattle, WA 98195-0005, USA Manuel Leyes, MD, PhD Section of Sports Medicine Department of Orthopaedics The Cleveland Clinic Foundation Cleveland, OH 44131-2143, USA David R. McAllister, MD Division of Sports Medicine University of California Los Angeles Los Angeles, CA 90095-8362, USA Michael H. Metcalf, MD University of Washington Seattle, WA 98195-0005, USA Timothy ]. Monahan, MD Geisinger Medical Center Danville, PA 17822-2130, USA Richard D. Parker, MD Sports Orthopaedic Rehabilitation Section of Sports Medicine Department of Orthopaedics The Cleveland Clinic Foundation Cleveland, OH 44195, USA Christian C. Perry, PA-C The Hughston Clinic Columbus, GA 31908, USA D.C. Peterson, MD, FRCS (C) University of Western Ontario London Health Sciences Centre Fowler Kennedy Sport Medicine Clinic London, ON N6A 3K7, Canada Walter R. Shelton, MD Mississippi Sports Medicine and Orthopaedic Center Jackson, MS 39202, USA L.M.F. Thain, AB, MD, FRCPC Department of Radiology and Surgery University of Western Ontario London Health Sciences Centre Diagnostic Radiology London, ON N6A 3K7, Canada Tracy M. Vogrin, MS Musculoskeletal Research Center University of Pittsburgh Pittsburgh, PA 15238-2887, USA Savio L.- Y. Woo, PhD, Dsc Musculoskeletal Research Center University of Pittsburgh Pittsburgh, PA 15238-2887, USA