The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study

The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study Libin Xu, Fangyong Lou, Haitao Jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5380206/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 7 You are reading this latest preprint version Abstract Background To investigate the effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction (PCLR). Methods A retrospective study was conducted to analyze 96 patients who underwent single-bundle reconstruction of posterior cruciate ligament (PCL) in our hospital from January 2020 to June 2023. The patients were divided into three groups according to the position of the endobutton on the lateral knee radiography. The first group is the position of endobutton in front of the lateral cortex of the femur, the second group is the position of endobutton in back of the lateral cortex of the femur, and the third group is the position of endobutton behind the femur. Knee Lysholm score, International Knee Documentation Committee (IKDC) Evaluation, Tegner Activity Scale, knee flexion angle and postoperative complication rate of the three groups were compared to evaluate whether there were statistical differences among the three groups. Results There were 39 patients in group 1, 46 patients in group 2, and 11 patients in group 3. The mean Lysholm Knee Scores of the group 1 was 91.77, 92.17 in group 2, and 90.36 in group 3. The mean IKDC Evaluation of group 1 was 90.48, 92.41 in group 2, and 93.00 in group 3. Tegner Activity Level was 5.69 in group 1, 5.72 in group 2, and 5.45 in group 3. The mean flexion degree was found as 125° in patients in group1, 127° in group 2, and 122° in group 3. There was no statistically significant difference between Lysholm Knee Scores ( p = 0.434), IKDC ( p = 0.068), Tegner Activity Level ( p = 0.797), and knee flexion angle ( p = 0.135). There was also no significant difference in the incidence of complications among the three groups ( p > 0.05). Conclusion There were not statistically differences in clinical functional results when comparing patients’ endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR. Posterior cruciate ligament reconstruction Endobutton Knee functional score Figures Figure 1 Figure 2 Background With the advent of the national sports era, PCL tears has become one of the most common sports injuries. PCL tears can lead to knee instability and knee cartilage injury, and accelerate knee degeneration[ 1 ]. Despite the fact that early PCL tears can achieve good clinical outcomes through non-surgical treatment, biomechanical experiments and long-term clinical studies have shown that non-surgical treatment is prone to poor knee function and early degeneration of the knee joint, surgeons often choose surgical methods to reconstruct PCL injuries in patients[ 2 , 3 ]. In particular, with the improvement of surgical methods, the postoperative effects have been significantly improved. Surgical treatment of PCL tears is performed by many techniques. The current focuses on the many facets of PCLR, including single versus double bundle reconstruction, tibial slope implications, graft selection, multiligamentous injury considerations, tunnel management, and onlay versus inlay tibial footprint creation[ 4 – 6 ]. However, the effect of the position of the femoral side fixation on knee function in the PCLR has not been fully determined[ 7 ], and that further research and studies are still needed. For the femoral side fixation of the graft, there are Cross-Pin and endobutton fixation. Cross-Pin is a direct fixation method, which takes a long time and has a high risk of neurovascular injury[ 8 , 9 ]. The endobutton is indirect fixation, simple operation, and widely used in clinical practice. Its advantages are simple and convenient operation, while its disadvantages include femoral tunnel enlargement and endobutton displacement into the joint cavity[ 10 ]. In the present study, it is aimed to retrospectively evaluate whether endobutton location have an effect on functional scores in patients who underwent single-bundle anatomical PCLR using the endobutton method. The hypothesis of the study was that the location of the endobutton in the femoral cortex was effective on functional results. Methods Patients A retrospective chart review of 96 patients who underwent single-bundle anatomical reconstruction of PCL in our institution between January 2020 to June 2023 was conducted. Patients who met any of the following criteria were included: (a) patients were over 18 years and under 50 years; (b) the donor ligaments of the ipsilateral limb were normal; (c) a minimum of 1-year outpatient follow-up and appropriate functional scoring in outpatient follow-up; (d)knee lateral X-ray performed in such a way as to show the location of the endobutton. Patients who met any of the following criteria were excluded: (a) concomitant with other knee ligament injuries; (b) ipsilateral limb donor ligaments were tough with the absence; (c) less than 1 year follow-up; (d) knee lateral radiography in rotation. Surgical technique The same orthopedic surgeon operated on all surgical procedures. Under general anesthesia, patients were positioned supine on the operating table. A repeat posterior drawer test proved positive. The standard anterior medial and lateral approaches were used. The PCL tear was confirmed and meniscus injuries were evaluated. The semitendinosus tendon and gracilis tendon were harvested and stored for used three-strand hamstring grafts. The arthroscope was placed into the posteromedial compartment through the anterolateral portal. The posteromedial portal was created. The arthroscope was placed into the posteromedial compartment through the posteromedial portal, across the posterior septum to the posterolateral compartment. The posterolateral portal was created. The tibial tunnel locator was placed along the PCL tibial insertion down to against the posterior capsule attachment, just lateral to the midline of the PCL insertion. A K-wire is drilled in. It was necessary to maintain knee flexion above 120 degrees to set up the femoral tunnel. The inner orifice of the femoral tunnel was located 12 mm from the most anterior edge of the PCL femoral footprint, and 8 mm from the distal cartilage margin, and the femoral tunnel was created sequentially with a K-wire and a drill to expected size and depth. With the guide suture, the graft was pried into the joint through the tibial tunnel and femoral tunnel with repeated maneuver of the switching stick. Endobutton was used for femoral fixation. Absorbable interface screw was used for tibial fixation[ 10 ]. Postoperative rehabilitation Routine postoperative antibiotics were administered for 24 h to prevent infection, and cold compress, was applied after surgery. On the first day, the patient performs ankle pump exercise and quadriceps isometric contraction. On the third day after surgery, the patient walks with crutches and wears a brace. Partial weight-bearing was allowed, and knee flexion and extension exercises were performed. One week later, the patient was discharged and had an X-ray of the knee joint checked. Knee flexion and extension are exercised to 90 degrees. The brace was worn for 3 months. Running was allowed 5 months after surgery, and sports participation was allowed 10–12 months after surgery. Clinical outcome assessment Clinical outcome assessment All the subjects underwent clinical assessments by the two same professional rehabilitation physicians during the follow-up. Outpatient follow-up was conducted at the 1 month, 3 months and 6 months postoperatively. After 6 months, the follow-up intervals were every 3 months, the time was at least 1 year. Knee function was evaluated by the Knee Lysholm score, IKDC score and Tegner Activity Scale. Knee flexion was an important index, it was evaluated separately. Postoperative complication was also evaluated. Preoperative and postoperative X-ray of the knee joints were also evaluated by the two same professional radiologists. The radiographs of the patients were taken with the patient standing and the knee in neutral rotation. Imaging evaluation Patients were divided into three groups according to the position of the endobutton on the femur side on the lateral knee radiography. On the lateral knee X-ray image, line A was the parallel lines of the anterior femur cortex, line B was the parallel lines of the posterior femur cortex. A transverse line was drawn along the upper margin of the patella to connect line A and line B, and another transverse line was drawn at least 10cm from the proximal femur of this transverse line to connect line A and line B. Take the midpoint of two horizontal lines and draw a vertical line as line C. The lateral cortex of distal femoral was divided into two equal parts by line C. According to these drawn lines, group 1 was in front of line C and group 2 is between line B and line C, two groups were in the lateral femur cortex. Group 3 was behind the lateral femur cortex (Fig. 1 ). Statistical analysis All statistical analyses were performed with SPSS 21.0 software. The continuous variables of the three groups were represented by mean ± standard deviation (mean ± SD). The comparison among three groups was performed using analysis of variance (ANOVA). Categorical variables were expressed as constituent ratio n (%) and chisquare test were used. p < 0.05 was considered to be statistically significant. Results A total of 96 participants met the inclusion criteria. Group 1included 39 patients, group 2 included 46 patients and group 3 included 11 patients. The mean age of group 1 was 34.87 ± 11.26 years, group 2 was 38.96 ± 13.04 years, and group 3 was 44.00 ± 12.49 years. The mean follow-up period of the patients was 16.59 ± 2.30 months in group 1, 16.76 ± 2.02 months in group 2, and 17.45 ± 1.69 months in group 3. Demographic data is presented in Table 1 . There was no statistical significance between the groups in terms of age ( p = 0.071), follow-up ( p = 0.489), sex ( p = 0.760), BMI ( p = 0.066), side ( p = 0.171), cause of injury ( p = 0.57), and time to surgery ( p = 0.226) (Tables 1 ). The mean Lysholm Knee Scores of group 1 was 91.77 ± 3.60, 92.17 ± 4.36 in group 2, and 90.36 ± 5.12 in group 3 (Table 2 ; Fig. 2 ). The mean IKDC Evaluation of group 1 was 90.48 ± 4.48, 92.41 ± 3.95 in group 2, and 93.00 ± 4.49 in group 3 (Table 2 ; Fig. 2 ). Tegner Activity Level was 5.69 ± 1.26 in group 1, 5.72 ± 1.11 in group 2, and 5.45 ± 1.13 in group 3 (Table 2 ; Fig. 2 ). The mean flexion degree was found as 125° in patients in group1, 127° in group 2, and 122° in group 3 (Table 2 ). There was no statistically significant difference between Lysholm Knee Scores ( p = 0.434), IKDC Evaluation ( p = 0.068), Tegner Activity Level ( p = 0.797), and knee flexion angle ( p = 0.135) among the three groups. During the arthroscopic surgery, meniscus tears were found in 83 patients. The data of meniscus lesions is presented in Table 3 . All of the meniscus lesions were repaired. There was no statistically significant difference was found in the presence of meniscus lesions and their location in a comparison of the groups ( p = 0.518) (Tables 3 ). There was also no significant difference in the incidence of complications between the three groups (Tables 4 ). In conclusion, there were no statistically significant differences in the demographic distribution of three groups, functional evaluation results and complication ( p < 0.05). It was found that the effect of endobutton location on the lateral knee radiography was not statistically significant. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward on the lateral knee during the PCLR. Discussion In the present study, we investigated whether endobutton location had an effect on functional scores in patients who underwent single-bundle anatomical PCLR using the endobutton method. In previous studies, the focus was the selection of grafts, the location of tibial tunnel and the location of femoral tunnel were widely studied during PCLR[ 11 , 12 ]. However, the effect of the position of the femoral side fixation on knee function in the PCLR had not been fully investigated. The technique of single-bundle anatomical PCLR was very mature. However, the femoral tunnel positioning method was still controversial, including the femur footprint location method and remnant location method[ 13 , 14 ]. The femur footprint location was preferred in this study. When opening the femoral tunnel, normally the guidewire was placed at the femur footprint of the PCL with the knee flexed at 90°. Then, the femoral tunnel is drilled by increasing the knee flexion to 120° by taking care to keep the guidewire fixed. Through this hole, the endobutton was placed over the lateral cortex with a flip. However, this angle may decrease or increase during PCLR. At the same time, the parallelism of the drill relative to the ground can be lost during the tunnel opening. During the arthroscopic surgery, although the entrance location of the femoral tunnel could be adjusted, the location of the exit hole was at a different location, sometimes at the back or at the front of the lateral femur cortex. In this study, the location of the endobutton on the femoral cortex was evaluated on lateral radiography of the knee. The patients were divided into three groups according to the location of the endobutton on the lateral knee radiographs. Endobutton location may differ depending on the flexion position of the knee during femoral drilling. Then patients were evaluated whether endobutton position had an effect on functional scores. In this publication, the effect of the exit hole of the femoral tunnel on functional scores was examined. Our first finding that endobutton location had not an effect on functional scores in patients who underwent single-bundle anatomical PCLR. Our results show that there were not statistically differences in clinical functional results when comparing patients’ endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR. At the same time, it can reduce the operation time. In this study, the effects of meniscus injuries on functional and other measurements were not evaluated separately. The second limitation is that the sample size was not large and multi-center. Third, the X-ray images are not dynamically reviewed multiple times. This study could not evaluate the position of footprint in femur as there was no computed tomography of the patients’ knees which may be regarded as another limitation. Despite these limitations, these results suggest several theoretical and practical implications. In this study, the place of the endobutton on the lateral femoral cortex was evaluated using lateral radiography of the knee. The femoral tunnel affects the tunnel placement, tunnel entrance, and exit holes due to its 3D structure. This research show that the location of endobutton on femur has not effect on knee clinical function. Conclusion There were not statistically differences in clinical functional results when comparing patients’ endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR. Abbreviations PCL posterior cruciate ligament PCLR posterior cruciate ligament reconstruction IKDC International Knee Documentation Committee ANOVA analysis of variance Declarations Acknowledgements We would like to thank all the staff in our Department of Orthopedics Author contributions Libin Xu and Haitao Jiang designed the study. Fangyong Lou collected the data and drafted the article. Libin Xu and Haitao Jiang performed the surgery and revised the manuscript. The authors read and approved the final manuscript. Libin Xu will handle correspondence at all stages of refereeing and publication, also post-publication. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Affiliated Taizhou People's Hospital of Nanjing Medical University. Informed consent was obtained from all patients included in the study. Consent for publication Informed consent was obtained from all the patients in this study for the article to be published. Competing interests The authors declare that they have no competing interests. References Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, et al. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018;6(1):8–18. Chahla J, Williams BT, LaPrade RF. Posterior Cruciate Ligament Arthrosc. 2020;36(2):333–5. Fanelli GC. Transtibial Posterior Cruciate Ligament Reconstruction. J Knee Surg. 2021;34(5):486–92. Akpinar B, DeClouette B, Gonzalez-Lomas G, Alaia MJ. Posterior Cruciate Ligament Reconstruction Current Concepts Review. Bull Hosp Jt Dis (2013). 2024;82(1):4–9. Stannard JP. Tibial Inlay Posterior Cruciate Ligament Reconstruction. Sports Med Arthrosc Rev. 2020;28(1):14–7. Wittenberg S, Sentuerk U, Renner L, Weynandt C, Perka CF, Gwinner C. [Importance of the tibial slope in knee arthroplasty]. Orthopade. 2020;49(1):10–7. Lee YS, Wang JH, Bae JH, Lim HC, Park JH, Ahn JH, et al. Biomechanical evaluation of cross-pin versus interference screw tibial fixation using a soft-tissue graft during transtibial posterior cruciate ligament reconstruction. Arthroscopy. 2009;25(9):989–95. Adriani E, Di Paola B, Alfieri A, De Fenu E. Femoral Fixation With Curve Cross-Pin System in Arthroscopic Posterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2018;7(4):e289–98. McKeon BP, Gordon M, DeConciliis G, Scheller A. The safe zone for femoral cross-pin fixation: an anatomical study. J Knee Surg. 2007;20(4):285–8. Zhao J. Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation. Arthrosc Tech. 2021;10(10):e2303–10. Wang B, Ye Y, Yao L, Wei A, Huang X, Wang Z, et al. Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis. BMC Musculoskelet Disord. 2023;24(1):93. Nicodeme JD, Locherbach C, Jolles BM. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1556–62. Song JG, Kim HJ, Han JH, Bhandare NN, Shetty GM, Kang SB, et al. Clinical Outcome of Posterior Cruciate Ligament Reconstruction With and Without Remnant Preservation. Arthroscopy. 2015;31(9):1796–806. Westermann RW, Sybrowsky C, Ramme AJ, Amendola A, Wolf BR. Three-dimensional characterization of the femoral footprint of the posterior cruciate ligament. Arthroscopy. 2013;29(11):1811–6. Tables Tables 1-4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Published Journal Publication published 19 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 20 Nov, 2024 Reviews received at journal 19 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers invited by journal 11 Nov, 2024 Editor assigned by journal 04 Nov, 2024 Submission checks completed at journal 03 Nov, 2024 First submitted to journal 02 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5380206","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377510412,"identity":"109f6358-20b1-4277-96bb-8795ab62b0b9","order_by":0,"name":"Libin Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYFACHoYDDAZgFuODhIoaIrUcMABRDMwGD84cI04L0BowxSb5sIWZsAb+aWcPHv5QYJNnz96dVpHYwMbA396dgFeLxO28BKDD0op5eM5uu5G4Q4ZB4szZDfituZ1jANRyOLFHIheo5Qwbg4FELn4t8shaChLbmAlrMUDWwkCUFkOQX84YpCX2nDm7WSLhzDEegn6Ru517+EPFH5vE9vbejR9/VNTI8bf3EvA+OuAhTfkoGAWjYBSMAqwAALS/UGfU9vfzAAAAAElFTkSuQmCC","orcid":"","institution":"the Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Libin","middleName":"","lastName":"Xu","suffix":""},{"id":377510413,"identity":"5f5fac62-be61-47f4-9581-7832812c2378","order_by":1,"name":"Fangyong Lou","email":"","orcid":"","institution":"the Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fangyong","middleName":"","lastName":"Lou","suffix":""},{"id":377510414,"identity":"406fb16c-143e-4e65-b0f3-ff263f614de6","order_by":2,"name":"Haitao Jiang","email":"","orcid":"","institution":"the Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haitao","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2024-11-03 02:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5380206/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5380206/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-024-05347-x","type":"published","date":"2024-12-19T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70380729,"identity":"fe2560ac-3056-472c-b47e-3f879f2f4f42","added_by":"auto","created_at":"2024-12-02 15:56:06","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45017,"visible":true,"origin":"","legend":"\u003cp\u003eDrawing on how the distal femur is divided into three parts on the femur distal lateral radiograph to form the groups\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5380206/v1/69ac6adc2b707a4cce1a6b0b.jpeg"},{"id":70381191,"identity":"7057325b-4adf-4597-9cc4-421f340edf9f","added_by":"auto","created_at":"2024-12-02 16:04:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37530,"visible":true,"origin":"","legend":"\u003cp\u003eComparative Lysholm Knee Scores, IKDC Evaluation, Tegner Activity Level results between the groups\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5380206/v1/a7fe618f0196cbd8f8318d58.png"},{"id":72201665,"identity":"5e1aae5c-d8ad-49f3-904e-b63d1fe2322f","added_by":"auto","created_at":"2024-12-23 16:09:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":419391,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5380206/v1/080d4cd3-b166-4965-b12c-ae2610862281.pdf"},{"id":70380730,"identity":"aa7ea2b1-0160-4fb9-88bb-dfbeabca3641","added_by":"auto","created_at":"2024-12-02 15:56:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17916,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5380206/v1/20f64efd0b275f1e33346318.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the advent of the national sports era, PCL tears has become one of the most common sports injuries. PCL tears can lead to knee instability and knee cartilage injury, and accelerate knee degeneration[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite the fact that early PCL tears can achieve good clinical outcomes through non-surgical treatment, biomechanical experiments and long-term clinical studies have shown that non-surgical treatment is prone to poor knee function and early degeneration of the knee joint, surgeons often choose surgical methods to reconstruct PCL injuries in patients[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn particular, with the improvement of surgical methods, the postoperative effects have been significantly improved. Surgical treatment of PCL tears is performed by many techniques. The current focuses on the many facets of PCLR, including single versus double bundle reconstruction, tibial slope implications, graft selection, multiligamentous injury considerations, tunnel management, and onlay versus inlay tibial footprint creation[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the effect of the position of the femoral side fixation on knee function in the PCLR has not been fully determined[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and that further research and studies are still needed.\u003c/p\u003e \u003cp\u003eFor the femoral side fixation of the graft, there are Cross-Pin and endobutton fixation. Cross-Pin is a direct fixation method, which takes a long time and has a high risk of neurovascular injury[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The endobutton is indirect fixation, simple operation, and widely used in clinical practice. Its advantages are simple and convenient operation, while its disadvantages include femoral tunnel enlargement and endobutton displacement into the joint cavity[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, it is aimed to retrospectively evaluate whether endobutton location have an effect on functional scores in patients who underwent single-bundle anatomical PCLR using the endobutton method. The hypothesis of the study was that the location of the endobutton in the femoral cortex was effective on functional results.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eA retrospective chart review of 96 patients who underwent single-bundle anatomical reconstruction of PCL in our institution between January 2020 to June 2023 was conducted.\u003c/p\u003e \u003cp\u003ePatients who met any of the following criteria were included: (a) patients were over 18 years and under 50 years; (b) the donor ligaments of the ipsilateral limb were normal; (c) a minimum of 1-year outpatient follow-up and appropriate functional scoring in outpatient follow-up; (d)knee lateral X-ray performed in such a way as to show the location of the endobutton.\u003c/p\u003e \u003cp\u003ePatients who met any of the following criteria were excluded: (a) concomitant with other knee ligament injuries; (b) ipsilateral limb donor ligaments were tough with the absence; (c) less than 1 year follow-up; (d) knee lateral radiography in rotation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003eThe same orthopedic surgeon operated on all surgical procedures. Under general anesthesia, patients were positioned supine on the operating table. A repeat posterior drawer test proved positive. The standard anterior medial and lateral approaches were used. The PCL tear was confirmed and meniscus injuries were evaluated. The semitendinosus tendon and gracilis tendon were harvested and stored for used three-strand hamstring grafts. The arthroscope was placed into the posteromedial compartment through the anterolateral portal. The posteromedial portal was created. The arthroscope was placed into the posteromedial compartment through the posteromedial portal, across the posterior septum to the posterolateral compartment. The posterolateral portal was created. The tibial tunnel locator was placed along the PCL tibial insertion down to against the posterior capsule attachment, just lateral to the midline of the PCL insertion. A K-wire is drilled in. It was necessary to maintain knee flexion above 120 degrees to set up the femoral tunnel. The inner orifice of the femoral tunnel was located 12 mm from the most anterior edge of the PCL femoral footprint, and 8 mm from the distal cartilage margin, and the femoral tunnel was created sequentially with a K-wire and a drill to expected size and depth. With the guide suture, the graft was pried into the joint through the tibial tunnel and femoral tunnel with repeated maneuver of the switching stick. Endobutton was used for femoral fixation. Absorbable interface screw was used for tibial fixation[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003ePostoperative rehabilitation\u003c/h3\u003e\n\u003cp\u003eRoutine postoperative antibiotics were administered for 24 h to prevent infection, and cold compress, was applied after surgery. On the first day, the patient performs ankle pump exercise and quadriceps isometric contraction. On the third day after surgery, the patient walks with crutches and wears a brace. Partial weight-bearing was allowed, and knee flexion and extension exercises were performed. One week later, the patient was discharged and had an X-ray of the knee joint checked. Knee flexion and extension are exercised to 90 degrees. The brace was worn for 3 months. Running was allowed 5 months after surgery, and sports participation was allowed 10\u0026ndash;12 months after surgery.\u003c/p\u003e\n\u003ch3\u003eClinical outcome assessment\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eClinical outcome assessment\u003c/div\u003e \u003cp\u003eAll the subjects underwent clinical assessments by the two same professional rehabilitation physicians during the follow-up. Outpatient follow-up was conducted at the 1 month, 3 months and 6 months postoperatively. After 6 months, the follow-up intervals were every 3 months, the time was at least 1 year. Knee function was evaluated by the Knee Lysholm score, IKDC score and Tegner Activity Scale. Knee flexion was an important index, it was evaluated separately. Postoperative complication was also evaluated. Preoperative and postoperative X-ray of the knee joints were also evaluated by the two same professional radiologists. The radiographs of the patients were taken with the patient standing and the knee in neutral rotation.\u003c/p\u003e\n\u003ch3\u003eImaging evaluation\u003c/h3\u003e\n\u003cp\u003ePatients were divided into three groups according to the position of the endobutton on the femur side on the lateral knee radiography. On the lateral knee X-ray image, line A was the parallel lines of the anterior femur cortex, line B was the parallel lines of the posterior femur cortex. A transverse line was drawn along the upper margin of the patella to connect line A and line B, and another transverse line was drawn at least 10cm from the proximal femur of this transverse line to connect line A and line B. Take the midpoint of two horizontal lines and draw a vertical line as line C. The lateral cortex of distal femoral was divided into two equal parts by line C. According to these drawn lines, group 1 was in front of line C and group 2 is between line B and line C, two groups were in the lateral femur cortex. Group 3 was behind the lateral femur cortex (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed with SPSS 21.0 software. The continuous variables of the three groups were represented by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD). The comparison among three groups was performed using analysis of variance (ANOVA). Categorical variables were expressed as constituent ratio n (%) and chisquare test were used. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 96 participants met the inclusion criteria. Group 1included 39 patients, group 2 included 46 patients and group 3 included 11 patients. The mean age of group 1 was 34.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.26 years, group\u003c/p\u003e \u003cp\u003e2 was 38.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04 years, and group 3 was 44.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.49 years. The mean follow-up period of the patients was 16.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30 months in group 1, 16.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 months in group 2, and 17.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69 months in group 3. Demographic data is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no statistical significance between the groups in terms of age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.071), follow-up (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.489), sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.760), BMI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.066), side (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.171), cause of injury (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.57), and time to surgery (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.226) (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean Lysholm Knee Scores of group 1 was 91.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60, 92.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36 in group 2, and 90.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12 in group 3 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean IKDC Evaluation of group 1 was 90.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48, 92.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95 in group 2, and 93.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49 in group 3 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Tegner Activity Level was 5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26 in group 1, 5.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 in group 2, and 5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 in group 3 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean flexion degree was found as 125\u0026deg; in patients in group1, 127\u0026deg; in group 2, and 122\u0026deg; in group 3 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no statistically significant difference between Lysholm Knee Scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.434), IKDC Evaluation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.068), Tegner Activity Level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.797), and knee flexion angle (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.135) among the three groups.\u003c/p\u003e \u003cp\u003eDuring the arthroscopic surgery, meniscus tears were found in 83 patients. The data of meniscus lesions is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. All of the meniscus lesions were repaired. There was no statistically significant difference was found in the presence of meniscus lesions and their location in a comparison of the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.518) (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was also no significant difference in the incidence of complications between the three groups (Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn conclusion, there were no statistically significant differences in the demographic distribution of\u003c/p\u003e \u003cp\u003ethree groups, functional evaluation results and complication (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). It was found that the effect of\u003c/p\u003e \u003cp\u003eendobutton location on the lateral knee radiography was not statistically significant. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward on the lateral knee during the PCLR.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we investigated whether endobutton location had an effect on functional scores in patients who underwent single-bundle anatomical PCLR using the endobutton method. In previous studies, the focus was the selection of grafts, the location of tibial tunnel and the location of femoral tunnel were widely studied during PCLR[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the effect of the position of the femoral side fixation on knee function in the PCLR had not been fully investigated.\u003c/p\u003e \u003cp\u003eThe technique of single-bundle anatomical PCLR was very mature. However, the femoral tunnel positioning method was still controversial, including the femur footprint location method and remnant location method[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The femur footprint location was preferred in this study. When opening the femoral tunnel, normally the guidewire was placed at the femur footprint of the PCL with the knee flexed at 90\u0026deg;. Then, the femoral tunnel is drilled by increasing the knee flexion to 120\u0026deg; by taking care to keep the guidewire fixed. Through this hole, the endobutton was placed over the lateral cortex with a flip. However, this angle may decrease or increase during PCLR. At the same time, the parallelism of the drill relative to the ground can be lost during the tunnel opening. During the arthroscopic surgery, although the entrance location of the femoral tunnel could be adjusted, the location of the exit hole was at a different location, sometimes at the back or at the front of the lateral femur cortex.\u003c/p\u003e \u003cp\u003eIn this study, the location of the endobutton on the femoral cortex was evaluated on lateral radiography of the knee. The patients were divided into three groups according to the location of the endobutton on the lateral knee radiographs. Endobutton location may differ depending on the flexion position of the knee during femoral drilling. Then patients were evaluated whether endobutton position had an effect on functional scores. In this publication, the effect of the exit hole of the femoral tunnel on functional scores was examined. Our first finding that endobutton location had not an effect on functional scores in patients who underwent single-bundle anatomical PCLR. Our results show that there were not statistically differences in clinical functional results when comparing patients\u0026rsquo; endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR. At the same time, it can reduce the operation time.\u003c/p\u003e \u003cp\u003eIn this study, the effects of meniscus injuries on functional and other measurements were not evaluated separately. The second limitation is that the sample size was not large and multi-center. Third, the X-ray images are not dynamically reviewed multiple times. This study could not evaluate the position of footprint in femur as there was no computed tomography of the patients\u0026rsquo; knees which may be regarded as another limitation.\u003c/p\u003e \u003cp\u003eDespite these limitations, these results suggest several theoretical and practical implications. In this study, the place of the endobutton on the lateral femoral cortex was evaluated using lateral radiography of the knee. The femoral tunnel affects the tunnel placement, tunnel entrance, and exit holes due to its 3D structure. This research show that the location of endobutton on femur has not effect on knee clinical function.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere were not statistically differences in clinical functional results when comparing patients\u0026rsquo; endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePCL posterior cruciate ligament\u003c/p\u003e\u003cp\u003ePCLR posterior cruciate ligament reconstruction\u003c/p\u003e\u003cp\u003eIKDC International Knee Documentation Committee\u003c/p\u003e\u003cp\u003eANOVA analysis of variance\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the staff in our Department of Orthopedics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLibin Xu and Haitao Jiang designed the study. Fangyong Lou collected the data and drafted the article. Libin Xu and Haitao Jiang performed the surgery and revised the manuscript. The authors read and approved the final manuscript. Libin Xu will handle correspondence at all stages of refereeing and publication, also post-publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Affiliated Taizhou People\u0026apos;s Hospital of Nanjing Medical University. Informed consent was obtained from all patients included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the patients in this study for the article to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, et al. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018;6(1):8\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChahla J, Williams BT, LaPrade RF. Posterior Cruciate Ligament Arthrosc. 2020;36(2):333\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFanelli GC. Transtibial Posterior Cruciate Ligament Reconstruction. J Knee Surg. 2021;34(5):486\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkpinar B, DeClouette B, Gonzalez-Lomas G, Alaia MJ. Posterior Cruciate Ligament Reconstruction Current Concepts Review. Bull Hosp Jt Dis (2013). 2024;82(1):4\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStannard JP. Tibial Inlay Posterior Cruciate Ligament Reconstruction. Sports Med Arthrosc Rev. 2020;28(1):14\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWittenberg S, Sentuerk U, Renner L, Weynandt C, Perka CF, Gwinner C. [Importance of the tibial slope in knee arthroplasty]. Orthopade. 2020;49(1):10\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YS, Wang JH, Bae JH, Lim HC, Park JH, Ahn JH, et al. Biomechanical evaluation of cross-pin versus interference screw tibial fixation using a soft-tissue graft during transtibial posterior cruciate ligament reconstruction. Arthroscopy. 2009;25(9):989\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdriani E, Di Paola B, Alfieri A, De Fenu E. Femoral Fixation With Curve Cross-Pin System in Arthroscopic Posterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2018;7(4):e289\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKeon BP, Gordon M, DeConciliis G, Scheller A. The safe zone for femoral cross-pin fixation: an anatomical study. J Knee Surg. 2007;20(4):285\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao J. Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation. Arthrosc Tech. 2021;10(10):e2303\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang B, Ye Y, Yao L, Wei A, Huang X, Wang Z, et al. Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis. BMC Musculoskelet Disord. 2023;24(1):93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNicodeme JD, Locherbach C, Jolles BM. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1556\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong JG, Kim HJ, Han JH, Bhandare NN, Shetty GM, Kang SB, et al. Clinical Outcome of Posterior Cruciate Ligament Reconstruction With and Without Remnant Preservation. Arthroscopy. 2015;31(9):1796\u0026ndash;806.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestermann RW, Sybrowsky C, Ramme AJ, Amendola A, Wolf BR. Three-dimensional characterization of the femoral footprint of the posterior cruciate ligament. Arthroscopy. 2013;29(11):1811\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1-4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Posterior cruciate ligament reconstruction, Endobutton, Knee functional score","lastPublishedDoi":"10.21203/rs.3.rs-5380206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5380206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo investigate the effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction (PCLR).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted to analyze 96 patients who underwent single-bundle reconstruction of posterior cruciate ligament (PCL) in our hospital from January 2020 to June 2023. The patients were divided into three groups according to the position of the endobutton on the lateral knee radiography. The first group is the position of endobutton in front of the lateral cortex of the femur, the second group is the position of endobutton in back of the lateral cortex of the femur, and the third group is the position of endobutton behind the femur. Knee Lysholm score, International Knee Documentation Committee (IKDC) Evaluation, Tegner Activity Scale, knee flexion angle and postoperative complication rate of the three groups were compared to evaluate whether there were statistical differences among the three groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 39 patients in group 1, 46 patients in group 2, and 11 patients in group 3. The mean Lysholm Knee Scores of the group 1 was 91.77, 92.17 in group 2, and 90.36 in group 3. The mean IKDC Evaluation of group 1 was 90.48, 92.41 in group 2, and 93.00 in group 3. Tegner Activity Level was 5.69 in group 1, 5.72 in group 2, and 5.45 in group 3. The mean flexion degree was found as 125\u0026deg; in patients in group1, 127\u0026deg; in group 2, and 122\u0026deg; in group 3. There was no statistically significant difference between Lysholm Knee Scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.434), IKDC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.068), Tegner Activity Level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.797), and knee flexion angle (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.135). There was also no significant difference in the incidence of complications among the three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThere were not statistically differences in clinical functional results when comparing patients\u0026rsquo; endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR.\u003c/p\u003e","manuscriptTitle":"The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 15:56:01","doi":"10.21203/rs.3.rs-5380206/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-20T05:29:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-19T21:41:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126142882271511053971759034535944244810","date":"2024-11-11T21:58:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-11T06:02:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-04T05:38:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-04T04:04:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-11-03T02:19:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6ec7442-2141-4de4-92f7-d4a17b585cfa","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:00:44+00:00","versionOfRecord":{"articleIdentity":"rs-5380206","link":"https://doi.org/10.1186/s13018-024-05347-x","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2024-12-19 15:57:14","publishedOnDateReadable":"December 19th, 2024"},"versionCreatedAt":"2024-12-02 15:56:01","video":"","vorDoi":"10.1186/s13018-024-05347-x","vorDoiUrl":"https://doi.org/10.1186/s13018-024-05347-x","workflowStages":[]},"version":"v1","identity":"rs-5380206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5380206","identity":"rs-5380206","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}