Archives of Orthopaedic and Trauma Surgery (2018) 138:377–385
ARTHROSCOPY AND SPORTS MEDICINE
Degenerative changes after posterior cruciate ligament reconstruction
are irrespective of posterior knee stability: MRI-based long-term
· Andreas Weiler
· Timm Denecke
· Julian M. M. Rogasch
· Heide Boeth
· Tobias M. Jung
Received: 30 August 2017 / Published online: 6 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Introduction Posterior cruciate ligament reconstruction (PCLR) is advocated to prevent an early onset of osteoarthritis. We
hypothesized that posterior instability after PCLR correlates with degenerative changes.
Materials and methods MRIs of 42 (12 female/30 male; 39 ± 9 years) patients were enrolled with a minimum 5-year follow-
up (FFU) after PCLR. In addition, 25 contralateral and 15 follow-up MRIs (12 months after baseline) were performed.
Degenerative changes were graded using WORMS. Posterior tibial translation (PTT) was measured using posterior stress
radiographs. Outcome parameters included WORMS/cartilage subscore for the whole joint, patellofemoral (PFJ), medial
(MFTJ), and lateral femorotibial joint (LFTJ).
Results Final follow-up was 101 (range 68–168) months. WORMS reached 41.5 [18.5–56.8]. Regional WORMS for PFJ
was signiﬁcantly higher than MFTJ and LFTJ. Cartilage subscore yielded 7 [2.8–15]. MFTJ and PFJ were signiﬁcantly
higher than LFTJ. Primary outcome parameters were signiﬁcantly higher than the contralateral knee (P < 0.0001) and sig-
niﬁcantly increased within 12 months (P = 0.0002). There was a signiﬁcant correlation between the intraoperative degree
of cartilage injury and WORMS (P < 0.0001 with r = 0.64) and between the number of previous surgery and the cartilage
subscore (P = 0.03 with r = 0.32). Meniscal surgery led to a signiﬁcantly higher WORMS (P = 0.035). Combined risk models
revealed that women below the mean age had signiﬁcantly lower WORMS (P = 0.001) and cartilage subscores (P = 0.003).
Conclusions Patients undergo degenerative changes after PCLR, which are signiﬁcantly higher compared to the contralateral
knee. These occur predominantly at PFJ/MFTJ and are irrespective of posterior stability. Concomitant meniscus/cartilage
injuries and a high number of previous surgeries are further risk factors.
Keywords Posterior cruciate ligament · PCL reconstruction · WORMS · Tibial slope · Cartilage · Osteoarthritis
* Clemens Gwinner
Julian M. M. Rogasch
Tobias M. Jung
Center for Musculoskeletal Surgery, Charité-University
Medicine Berlin, Augustenburger Platz 1, 13353 Berlin,
Sporthopaedicum, Berlin, Germany
Center for Radiology and Nuclear Medicine,
Charité-University Medicine Berlin, Berlin, Germany
Julius Wolﬀ Institute, Charité-University Medicine Berlin,