Impact of Ligamentous Adhesion to the Posterior Cruciate Ligament on Radiological, Arthroscopic, and Clinical Outcomes One Year After ACL Reconstruction: A Cohort Study

Abstract

Background: The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) play a crucial role in maintaining knee stability by controlling anterior and posterior tibial translation. After ACL reconstruction, residual ACL tissue may adhere to the PCL, potentially affecting postoperative recovery. This study aimed to evaluate the relationship between ACL–PCL adhesion and radiological, arthroscopic, and clinical outcomes one year after ACL reconstruction. Materials and Methods: This retrospective cohort study included patients with ACL tears who underwent reconstructive surgery at hospitals in Tehran between 2022 and 2023. Patients were divided into two groups based on arthroscopic findings: those with ACL remnant adhesion to the PCL and those without adhesion. Demographic data, postoperative MRI findings (chondral lesions, articular cartilage damage, meniscal injuries, varus deformity, and concomitant ligament injuries), and clinical outcomes assessed by Lachman and pivot shift tests were compared between groups. Statistical analysis was performed using SPSS software using chi-square and McNemar’s tests. Results: A total of 87 patients were evaluated (mean age 30.42 ± 5.79 years), including 78 males and 9 females. ACL remnant adhesion to the PCL was observed in 74 patients (85.1%). Articular cartilage damage was more frequent in the non-adhesion group (23.1%). Medial meniscal injuries were present in 56.3% of patients and were more common in the non-adhesion group (76.9%). Lateral and root meniscal injuries, as well as concomitant MCL and PCL injuries, were more frequently observed in the adhesion group. Varus deformity showed no significant association with adhesion status. No significant differences were found in Lachman or pivot shift test results, and adhesion was not associated with age or gender. Conclusion: ACL remnant adhesion to the PCL is a common finding after ACL reconstruction but was not associated with adverse radiological findings or short-term clinical outcomes. Further studies are needed to assess its long-term clinical relevance.