2017 ISAKOS Biennial Congress ePoster #1811

 

PCL Reconstruction And Clinical Outcome – A Radiological Predictive Method Using Tibial Exit Site

Denny T. T. Lie, MBBS, FRCS, FAMS, Singapore SINGAPORE
Mohd Tauheed, MD, Singapore SINGAPORE

Singapore General Hospital, Singapore, Singapore, SINGAPORE

FDA Status Not Applicable

Summary

Post PCL surgery: Radiographic measurements from tibial exit site to tip of fibula head was found to strongly correlate with clinical outcome scores.

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Abstract

Aim

This study was designed to look at possible radiological method to predict outcome of PCL reconstruction and to analyse if there is a correlation between that and the subjective outcomes of patients’ Lysholm score.

Material And Methods

A retrospective clinical study in which data of 37 patients, who had undergone PCL reconstruction more than 2years prior, were retrieved, their X-rays studied and measurements were recorded. Measurements are done by drawing 2 lines that are perpendicular to the tibia longitudinal axis; one at the top of the tibial plateau and the other, at the head of fibula. The mid-point of the tibial exit site, point x, is identified and a line from this point is drawn to the previously drawn perpendicular lines. The 2 lengths, Plateau Tunnel Length (PTL) and Fibula Tunnel Length (FTL) are then measured. The patients were also called up to complete Lysholm questionnaires for assessment of the subjective outcome. Correlation and scatter plots were then derived.

Results

30 out of the 37 patients responded to the follow-up interview, their post op Lysholm score averaged 86.34 (±9.6), a significant improvement from 71.73 (pre-op). Their X-rays were evaluated and the lengths PTL and FTL were measured and recorded. PTL averaged 15.54 ± 5.15mm, ranging from 5.21 to 27.33 mm. FTL averaged 10.32 ± 4.84mm (2.25 to 18.94 mm). The correlation for improvement in Lysholm score and PTL was 0.78 while the correlation of improvement in Lysholm score and FTL is -0.92.

Conclusion

Clinical scores do improve after PCL reconstruction. We report a novel finding that there exists a correlation between the clinical outcomes of PCL reconstruction and the tibial tunnel as determined on the X-rays. Better functional outcomes were seen when the exit point is closer to the tip of the fibula. We propose that the point where the tibial tunnel exits, measured radiologically from the tip of fibula, can be used to improve outcomes both intra- and post-operatively.