Modified Postoperative Rehabilitation Including Dynamic Posterior Cruciate Ligament Brace to Reduce Recurrence of Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: A Retrospective Comparative Cohort Study.

Abstract

Background: Recurrence of posterior tibial translation (PTT) is one of the challenges of posterior cruciate ligament (PCL) reconstruction. Several studies have emphasized the importance of protecting the transplanted graft. However, the impact of such protective measures on clinical outcomes has rarely been investigated.

Purpose/hypothesis: The purpose of this study was to compare postoperative outcomes between conventional and modified rehabilitation (CR and MR, respectively) protocols after double-bundle PCL reconstruction. It was hypothesized that an MR protocol designed to protect the transplanted graft, combined with a dynamic PCL brace, would improve PTT and patient-reported outcomes (PROs) compared with CR.

Study design: Cohort study; Level of evidence, 3.

Methods: This study included 25 patients with isolated grade 2 or 3 PCL injuries who underwent double-bundle reconstruction using autogenous hamstring grafts between 2017 and 2022. Patients were categorized into 2 groups: the CR group (n = 14), which received CR without a dynamic PCL brace, and the MR group (n = 11), which received MR with a dynamic PCL brace. PTT was evaluated by gravity sag view radiographs preoperatively, immediately after surgery, and at 3 months, 6 months, 1 year, and 2 years after surgery. PROs were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years.

Results: PTT decreased from preoperative to immediate postoperative evaluation in both groups without a significant difference between the 2 groups (CR group: 9.9 ± 3.0 mm to -1.0 ± 1.9 mm; MR group: 9.6 ± 3.5 mm to -1.4 ± 0.5 mm). At 3 months, 6 months, 1 year, and 2 years after surgery, the CR group demonstrated PTT of 3.7 ± 1.5, 4.0 ± 1.7, 4.4 ± 1.6, and 4.7 ± 1.7 mm, respectively, whereas the MR group demonstrated significantly smaller values of 0.8 ± 1.9, 1.9 ± 1.6, 2.6 ± 2.1, and 2.6 ± 2.2 mm, respectively (P < .05). Residual posterior sagging (PTT >5 mm) occurred in 29% of the CR group and 9% of the MR group (P = .34). No major complications were observed. The KOOS Sport and Recreation subscale score tended to be higher in the MR group.

Conclusion: MR with a dynamic PCL brace to protect the graft significantly improved tibial position after PCL reconstruction compared with CR, without increasing the risk of complications.