Posterior trans-septum portal approach versus anterior approach for posterior cruciate ligament reconstruction

Objective To compare the posterior trans-septum portal approach and the anterior approach for anatomic single-bundle reconstruction of the posterior cruciate ligament (PCL).Methods We reviewed 60 patients who had undergone anatomic single-bundle reconstruction of PCL from January 2008 to January 2012.They were divided into 2 groups according to surgical approaches used.In the conventional group,28 patients received early PCL reconstruction via the anterior approach.They were 17 males and 11 females,with a mean age of 33.0 ± 9.4 years.In the trans-septum group,32 patients received late PCL reconstruction via the posterior trans-septum portal approach.They were 22 males and 10 females,with a mean age of 32.2 ± 8.0 years.The 2 groups were compared in terms of tibial tunnel site distance,KT-2000 value,posterior drawer test result,neurovascular lesion,and Lysholm knee function and IKDC (International Knee Documentation Committee) scores at the last follow-up.Results The conventional and the trans-septum groups were followed up for 15.9 ± 2.2 and 15.6 ± 2.0 months respectively,with no significant difference (P ＞ 0.05).The conventional group yielded significantly better results than the trans-septum group regarding tibial tunnel site distance,KT-2000 value,negative rate of posterior drawer test [90.6％ (29/32) versus 75.0％ (21/28)],Lysholm knee function and IKDC scores (90.9 ± 3.0 and 88.3 ± 3.5 points versus 87.8 ± 2.9 and 85.4 ± 3.7 points) (P ＜ 0.05).Two patients in the conventional group had neurovascular symptoms which responded to the treatment.Conclusion In the anatomic single-bundle reconstruction of PCL,the posterior trans-septum portal approach may result in better outcomes than the conventional anterior approach in terms of facilitating recovery of knee joint stability. Key words: Posterior cruciate ligament;  Arthroscopy;  Approach