TABLE 2.
PCL Studies Outcomesa
| Study | LOE | Design | N | Country | Study Period | Injury-Surgery, mo, Mean ± SD (Range) | Type of PCLR | Rehabilitation | Follow- up, Mean (Range) | Outcome Measures | Recommendation |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Boutefnouchet4 | 4 | CS | 15 | UK | Unknown | 15.5 (2-74) | Hamstring 4-stand SB transtibial | CPM 12 h, FWB 24 h, no brace + FROM by 2-3 wk, jog 3 mo, light sport 6 mo, contact sport 9-12 mo | 4.1 y (1-9) | Lysholm, Tegner, IKDC, KT-2000 | Very good restoration of knee kinematics and function with a majority of patients returned to preinjury level sport. |
| Chan6 | 4 | CS | 20 | Taiwan | 1999-2001 | 4 (3-12) | Hamstring 4-strand SB transtibial | Functional brace PWB 1 wk, FWB 6 wk, FROM 8 wk, normal activity 3 mo, light sport 6 mo, full sport 9 mo | 40 mo (36-50) | Lysholm, Tegner, IKDC, thigh muscle assessment, radiographic assessment, KT-1000 | Satisfactory functional outcomes with significant Tegner improvement post surgery. No RTS data. |
| Garofalo13 | 4 | CS | 15 | Italy | Unknown | 10.6 ± 2.5 | Patellar tendon–bone and semitendinosus autograft—DB transtibial | Extension 3 wk, PWB 6 wk, FWB 8 wk, 0°-70° ROM 4 wk, RTS 9 mo | 3.2 y (2-5) | IKDC, IKDC 2000, Lysholm, Tegner, HSS | Significant improvement in knee scores from DB PCLR, but no patients resumed preinjury level of sporting activities. |
| Lee24 | 4 | CS | 45 | Korea | 2006-2011 | 9.4 ± 3.5 | 45 patients: transtibial SB allograft remnant sparing | Extension 12 wk, TWB 4 wk, FWB 6 wk, light running 12 wk, RTS 6 mo | 48.2 ± 16.2 mo | Lysholm, Tegner, IKDC subjective, radiography MRI (n = 34), second-look scope (n = 36), KT-2000, Biodex proprioception | Transtibial remnant-preserving PCLR results in satisfactory clinical, radiologic, and morphologic outcomes. No RTS data. |
| Li25 | 3 | CC | 37 | China | 2005-2009 | Group 1: 8.9 ± 2.4 Group 2: 9.3 ± 2.9 | Group 1: 4-strand hamstring SB transtibial Group 2: allograft tibialis anterior tendon transtibial | Extension 4 wk, 12 wk PWB, normal activities 3 mo, light sport 6 mo, full preinjury sport 9-12 mo | Group 1: 2.3 y Group 2: 2.4 y | Lysholm, Tegner, IKDC rating, knee laxity arthrometer | Significant clinical improvements with both hamstring and tibialis anterior PCLR, no significant difference between graft types. No RTS data. |
| MacGillivray29 | 3 | CC | 20 | USA | 1980-1997 | Not stated | Group 1: transtibial (autologous BPTB, allograft BPTB, allograft Achilles) Group 2: tibial inlay (autologous BPTB, allograft BPTB) | Extension 4-6 wk, TWB 4 wk, PWB 2 wk, full activities 9-12 mo | Group 1: 6.3 y (2.4-15) Group 2: 4.7 y (2-7) | Tegner, Lysholm, AAOS knee scale, KT-1000 | Significant clinical improvement with PCLR. Majority of patients did not RTS. No significant difference between PCLR techniques. |
| Mariani30 | 4 | CS | 24 | Italy | 1991-1994 | 32 (11-192) | Arthroscopic BPTB transtibial PCLR | First 9 patients: ROM 1 wk, NWB 6 wk Last 15 patients: FWB PROM day 2, bicycle 4 wk, swim 8 wk, run 12 wk, RTS 6 mo | 26.5 mo (24-53) | Lysholm, Tegner, IKDC, KT-2000 | Chronic PCLR significantly results in significant activity improvement with 50% RTS rate. |
| Mygind-Klavsen35 | 3 | CS | 77 | Denmark | 2002-2010 | Not stated | Arthroscopic transtibial hamstring graft DB | NWB 6 wk, HKB 8 wk with gradual ROM | 5.9 y (3.1-9.7) | IKDC, KOOS, Tegner, KT-1000 | PCLR in isolated PCL injury knees have better outcome scores vs PCLR in multiligamentous injuries with a mean sports and recreation KOOS score of 56. |
| Noh36 | 4 | CS | 28 | Korea | 2010-2013 | 2 (1.6-16.5) | Achilles allograft looped transtibial tunnel remnant preserved | PWB day 2, FWB 2 wk, extension 5 wk, light exercise 3 mo, noncontact sport 9 mo, RTS 1 y | 27.7 ± 4.8 mo | Lysholm, IKDC, Tegner | Multiple-looping PCLR has satisfactory clinical outcomes. No RTS data. |
| Osti37 | 4 | CS | 39 | Austria | 2008-2012 | 20.7 ± 45.6 (0.4-244) | Arthroscopic tibial inlay quads tendon SB | PWB 4 wk, PCL brace with 50° flexion 4 wk, RTS 9-12 mo | 45.6 ± 21.6 mo | Lysholm, IKDC, Tegner, VAS, KOOS | Beneficial subjective and objective outcomes in the medium term with a mean sports and recreation KOOS score of 65.35. |
| Song46 | 3 | CC | 66 | Korea | 1990-2001 | 12.2 | Group 1: transtibial hamstring SB Group 2: tibial inlay BPTB | Extension 3 wk, PWB at 8 wk, FWB at 12 wk, low-impact sports 6 mo, contact sports 9 mo | Group 1: 139 ± 27.4 mo Group 2: 144 ± 26.7 mo | Lysholm, IKDC, Tegner, return to preinjury sports, postdraw, laxity Telos, OA development | Significant clinical improvement in both techniques with significant difference. No significant difference in RTS. |
| Yang52 | 2 | CC | 58 | Korea | 2001-2009 | Group 1 = 9.7 mo Group 2 = 9.2 mo | Group 1: transtibial SB mixed tibialis anterior autologous hamstring remnant preserved Group 2: transtibial SB allograft Achilles tendon remnant preserved | Extension 4 wk, PWB 4 wk, FWB 6 wk, return to full activities 9-12 mo | Group 1: 60 ± 21 mo Group 2: 58 ± 18 mo | Lysholm, Tegner, IKDC, Telos, second-look scope: group 1 66.7%, group 2 75% | Satisfactory clinical outcomes in both techniques. Higher intraoperative complication rate with Achilles tendon graft use. No RTS data. |
| Yoon53 | 2 | RCT | 58 | Korea | 2007-2007 | Group 1 = 37 (3-259) Group 2 = 35 (3-131) | Group 1: transtibial SB allograft Achilles remnant preserved Group 2: transtibial DB | Extension NWB 3 wk, FWB 6 wk, return to sports 1 y | Group 1: 31 mo (24-42) Group 2: 33 mo (24-43) | ROM, posterior stress radiography, Tegner, Lysholm, IKDC | DB PCLR resulted in better objective posterior stability than SB PCLR but no difference in clinical outcomes. Both techniques show significant Tegner improvement. No RTS data. |
| Zayni54 | 4 | CS | 21 | France | 2005-2008 | 28 (0.75-95) | SB transtibial autologous hamstring | Extension 45 d, RTS 7 mo | 29 mo (12-48) | IKDC, Tegner, Lysholm, Telos | PCLR resulted in significant improvements in clinical outcomes. A high number of patients had an RTS. Higher preinjury function resulted in better outcomes. |
aAAOS, American Academy of Orthopaedic Surgeons; BPTB, bone–patellar tendon–bone; CC, case-control study; CPM, continuous passive motion; CS, case series; DB, double bundle; FROM, functional range of motion; FWB, full weightbearing; HKB, hinged knee brace; HSS, Hospital for Special Surgery; IKDC, International Knee Documentation Committee; Injury-Surgery, time from injury to surgery; KOOS, Knee injury and Osteoarthritis Outcome Score; LOE, Level of evidence; MRI, magnetic resonance imaging; NWB, nonweightbearing; OA, osteoarthritis; PCL, posterior cruciate ligament; PCLR, posterior cruciate ligament reconstruction; PWB, partial weightbearing; RCT, randomized controlled trial; ROM, range of motion; RTS, return to sport; SB, single bundle; TWB, touch weightbearing; VAS, visual analog scale.