Long-term results of posterior cruciate ligament tear with or without reconstruction: A nationwide, population-based cohort study

There is increasing interest in the long-term outcomes of patients with posterior cruciate ligament (PCL) tears following conservative treatment or reconstruction. However, limited information is available regarding these results because of the relative rarity of cases and lack of long-term follow-u...

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Bibliographic Details
Published in:PloS one 2018-10, Vol.13 (10), p.e0205118-e0205118
Main Authors: Wang, Sheng-Hao, Chien, Wu-Chien, Chung, Chi-Hsiang, Wang, Yung-Chih, Lin, Leou-Chyr, Pan, Ru-Yu
Format: Article
Language:English
Subjects:
Analysis
Arthritis
Arthroplasty
Biocompatibility
Biology and Life Sciences
Biomedical materials
Cohort analysis
Complications
Confidence intervals
Degeneration
Hazards
Health aspects
Health insurance
Health risks
Incidence
Injuries
Knee
Medicine and Health Sciences
Meniscus
Osteoarthritis
Patients
Population studies
Population-based studies
Posterior cruciate ligament
Reconstruction
Risk
Risk reduction
Social Sciences
Statistical models
Studies
Surgical implants
Tearing
Treatment outcome
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Summary:There is increasing interest in the long-term outcomes of patients with posterior cruciate ligament (PCL) tears following conservative treatment or reconstruction. However, limited information is available regarding these results because of the relative rarity of cases and lack of long-term follow-up. The goals of this study are to (1) compare the occurrence of secondary meniscal tears, osteoarthritis (OA) or subsequent total knee replacement (TKR) in patients with or without PCL injury, and (2) evaluate the potential protective effect of PCL reconstruction against long-term sequela in patients with PCL deficiency. Cohort study; Level of evidence, 3. This retrospective cohort study evaluated the long-term results of PCL deficiency with or without reconstruction in Taiwan based on data from the National Health Insurance Research Database (NHIRD) from 2000 to 2015. The cumulative incidence rates of meniscus tear, OA and TKR were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 4,169 patients diagnosed with PCL tear from 2000 to 2015 in Taiwan were included in the study. There was a higher cumulative incidence of meniscus tear (1.13%), OA (2.71%) and subsequent TKR (0.91%) among patients with a PCL tear than among patients without one (0.22%, 1.90%, 0.62%; all p < 0.05). PCL reconstruction patients had a decreased cumulative incidence of meniscus tear (0.41%), OA (2.30%) and subsequent TKR (0.48%) compared with non-reconstructed patients (2.44%, 3.46%, 1.69%; all p < 0.05). After adjusting for covariates, PCL-injured patients who underwent reconstruction within one year after PCL injury showed a significantly lower risk of subsequent sequelae than those who never underwent reconstruction (within 1 month: adjusted HR = 0.390, 95% CI = 0.284-0.535; 1 month to 1 year: adjusted HR = 0.546, 95% CI = 0.398-0.748). Patients with PCL tears have a significantly higher risk of meniscus tear, OA and subsequent TKR than patients without PCL tears. PCL reconstruction could decrease the cumulative incidence of these outcomes. The results suggest that PCL-injured patients should undergo reconstruction as early as possible (within one year) to reduce the risk of further degeneration.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0205118