J Knee Surg 2020; 33(06): 553-559
DOI: 10.1055/s-0039-1681029
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Posterior Cruciate Ligament Reconstruction: The Achilles Tendon Allograft versus the Quadriceps Tendon Allograft

Seung Hoon Kang
1   Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
Kang Min Sohn
2   Department of Orthopaedic Surgery, Himchan Hospital, Busan, Republic of Korea
Do Kyung Lee
3   Department of Orthopedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Republic of Korea
Byung Hoon Lee
4   Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, Republic of Korea
Seong Wook Yang
1   Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
Joon Ho Wang
5   Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

24 May 2018

10 January 2019

Publication Date:
01 March 2019 (online)


We aimed to compare and analyze the outcomes of arthroscopic posterior cruciate ligament (PCL) reconstruction with the Achilles tendon allograft and the quadriceps tendon allograft. Twenty-nine patients who received the same procedure of arthroscopic PCL reconstruction within our inclusion criteria were reviewed retrospectively. There were 13 patients in the Achilles tendon allograft group and 16 patients in the quadriceps tendon allograft group. At least in 2 years of follow-up period, we evaluated the patients using the posterior drawer test, KT 2000 test, Lysholm knee scoring scale, Tegner activity scale score, International Knee Documentation Committee (IKDC) subjective knee form score, and Telos stress radiography. Between the two groups, no differences were found in preoperative patient demographic factors (age, gender, mean time of surgery, average follow-up period, cause of injury, and combined injury) (p > 0.05). Results of the posterior drawer test, KT 2000 test, Telos stress radiography, Lysholm score, Tegner activity score, and IKDC subjective score were not significantly different between the two groups at preoperative evaluation and after surgery (p > 0.05). On comparing preoperative evaluation and follow-up after surgery, the Achilles tendon allograft group showed significant improvement in the results of the KT 2000 test, Telos stress radiology, and Lysholm score, whereas the quadriceps tendon allograft group showed significant improvement in the results of the KT 2000 test, Telos stress radiology, Lysholm score, Tegner activity score, and IKDC subjective score (p < 0.05). The quadriceps tendon for arthroscopic PCL reconstruction is good alternative allograft for the Achilles tendon for arthroscopic PCL reconstruction. This is a retrospective comparative study.

  • References

  • 1 Ahn JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft--clinical results of a minimum 2-year follow-up. Arthroscopy 2005; 21 (08) 965-969
  • 2 Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 2012; 40 (01) 222-231
  • 3 Mabe I, Hunter S. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison. Cell Tissue Bank 2014; 15 (04) 523-529
  • 4 Kim JG, Yang SJ, Lee YS, Shim JC, Ra HJ, Choi JY. The effects of hamstring harvesting on outcomes in anterior cruciate ligament-reconstructed patients: a comparative study between hamstring-harvested and -unharvested patients. Arthroscopy 2011; 27 (09) 1226-1234
  • 5 LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med 2015; 43 (12) 3077-3092
  • 6 Eagan MJ, McAllister DR. Biology of allograft incorporation. Clin Sports Med 2009; 28 (02) 203-214 , vii
  • 7 Hjorthaug GA, Madsen JE, Nordsletten L, Reinholt FP, Steen H, Dimmen S. Tendon to bone tunnel healing--a study on the time-dependent changes in biomechanics, bone remodeling, and histology in a rat model. J Orthop Res 2015; 33 (02) 216-223
  • 8 Weiler A, Hoffmann RF, Bail HJ, Rehm O, Südkamp NP. Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 2002; 18 (02) 124-135
  • 9 Yang JH, Yoon JR, Jeong HI. , et al. Second-look arthroscopic assessment of arthroscopic single-bundle posterior cruciate ligament reconstruction: comparison of mixed graft versus Achilles tendon allograft. Am J Sports Med 2012; 40 (09) 2052-2060
  • 10 Waligora AC, Johanson NA, Hirsch BE. Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee. Clin Orthop Relat Res 2009; 467 (12) 3297-3306
  • 11 Ahn JH, Chung YS, Oh I. Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 2003; 19 (01) 101-107
  • 12 Irrgang JJ, Anderson AF, Boland AL. , et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
  • 13 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
  • 14 Schulz MS, Russe K, Lampakis G, Strobel MJ. Reliability of stress radiography for evaluation of posterior knee laxity. Am J Sports Med 2005; 33 (04) 502-506
  • 15 Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. Am J Sports Med 2013; 41 (01) 35-42
  • 16 Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med 2013; 41 (07) 1526-1533
  • 17 Lee DY, Kim DH, Park JS. , et al. Systematic review of cadaveric studies on anatomic posterior cruciate ligament reconstruction: the landmarks in anatomic posterior cruciate ligament reconstruction. Knee Surg Relat Res 2014; 26 (04) 191-198
  • 18 Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H. Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy 2001; 17 (05) 461-476
  • 19 Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am 1976; 58 (03) 350-355
  • 20 Marinozzi G, Pappalardo S, Steindler R. Human knee ligaments: mechanical tests and ultrastructural observations. Ital J Orthop Traumatol 1983; 9 (02) 231-240
  • 21 Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res 1976; (117) 263-270
  • 22 Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 1994; 27 (01) 13-24
  • 23 Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. J Biomech 2006; 39 (01) 1-20
  • 24 Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 2000; 28 (02) 144-151
  • 25 Amis AA, Bull AM, Gupte CM, Hijazi I, Race A, Robinson JR. Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 2003; 11 (05) 271-281
  • 26 Race A, Amis AA. PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 1998; 80 (01) 173-179
  • 27 Sasaki N, Farraro KF, Kim KE, Woo SL. Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study. Am J Sports Med 2014; 42 (03) 723-730
  • 28 Shani RH, Umpierez E, Nasert M, Hiza EA, Xerogeanes J. Biomechanical comparison of quadriceps and patellar tendon grafts in anterior cruciate ligament reconstruction. Arthroscopy 2016; 32 (01) 71-75
  • 29 Kongsgaard M, Nielsen CH, Hegnsvad S, Aagaard P, Magnusson SP. Mechanical properties of the human Achilles tendon, in vivo. Clin Biomech (Bristol, Avon) 2011; 26 (07) 772-777