POSTER ABSTRACTS - ISAKOS

surgically treated, during the acute phase. Mean
age was 33,1 years. Cause of injury was road traffic
accident in 21 cases, sport accident in 2 cases and
work accident in 1 case.
In 12 incidents accompanied rupture of lateral
structures was seen and in 6 rupture of medial
structures, while in 20 cases participation of
posterior structures was observed. Isolated injury
of central structure (ACL and PCL) was in only 2
patients observed. 3 segond fractures were seen, 2
chondral lesions, 3 neurogical events while no
vascular injury was observed .
In all cases the damaged ligaments were
anatomically exposed and reconstructed. The
autologous grafts mostly used for reconstruction,
are BPTB for PCL and quadriceps tendon for ACL
reconstruction.
Postoperatively, an accelerated program of
rehabilitation was introduced, aiming in
progressive mobilization of the joint and muscle
endurance.
Results: Twenty-three out of 24 patients (95,8%)
were followed up. Three patients were reoperated
because of inadequate movement of the knee
joint. Evaluation of the results was performed
with KT-1000, IKDC, Lysholm and Tegner score
and at an average 54,7 months after the injury.
Mean anterior translation on KT-1000 testing was
7,1 mm (20o flexion - 89 Newton’s), mean
posterior translation was 5,0 mm (70o flexion - 89
Newton’s) and mean difference compared to the
uninvolved side was 1,8 mm and 2,3 mm,
respectively. IKDC score was A in 5 cases, B in 10,
C in 5 and D in 3; Average Lysholm score was
86,78% (range 53 to 100); Average Tegner score
was 4,69 before accident and 4,04 in
reexamination.
Conclusions: Treatment of such injuries remains
controversial. Recent literature tends to abandon
conservative treatment and inclines to operative
procedures. In our opinion aggressive evaluation,
treatment and rehabilitation of these injuries are
necessary to achieve optimal results.
E-poster #620
Combination Posterior Drawer Test to
Differentially Diagnose Isolated or Combined
Injuries to the Posterior Cruciate Ligament and
Posterolateral Structures of the Knee
Yasunori Suda, Tokyo, JAPAN, Presenter
Hideo Matsumoto, Tokyo, JAPAN
Toshiro Otani, Tokyo, JAPAN
Kenichiro Matsuzaki, Tokyo, JAPAN
Department of Orthopedic Surgery, Keio
University, Tokyo, JAPAN
In order to differentially diagnose isolated or
combined injuries to the PCL and posterolateral
structures, we developed a novel clinical
examination, 'Combination Posterior Drawer Test',
in which integrity of the PCL or that of the
posterolateral structures is directly reflected on
the results, based on our previous experimental
data. This test is consisted of two steps; neutral
posterior drawer test (NPDT), as conventional
manner, which is performed at 90 degrees of knee
flexion with axial tibial rotation constrained to the
neutral position, and the other, new concept,
maximum external posterior drawer test (MEPDT),
in which the tibia is held at maximum externally
rotational position during the push phase. The
aim of this study was to verify the usefulness of
combination PDT clinically. Eleven cases of
chronic PCL injury and 3 cases of combined PCL
and posterolateral structures injuries were
examined. In all 14 patients, NPDT and MEPDT
were performed. In all isolated PCL injured
patients, anterior-posterior tibial displacement
was measured with KT-2000 first at neutral tibial
rotation, then at maximum external rotation in
the 70 degrees flexed knees. In isolated PCL
deficient patients, NPDT was all positive (grade 1
in 3 cases, grade 2 in 6, grade 3 in 2) and MEPDT
was all negative. On the other hand, in combined
cases, both tests were grade 3 positive. In isolated
PCL injured patients, anterior-posterior tibial
displacement (under between 134N anterior force
and 87N posterior force) measured at neutral
rotation was significantly larger in the injured side
(14.8±3.5mm) than that in the contralateral
normal side (7.5±2.0mm). However, at maximum
external rotation, there was no significant
difference in the values measured between the
injured side and the normal side. These results
indicate that combination PDT is useful to
distinguish isolated PCL injury from combined
PCL and posterolateral structures injuries.