{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:31:47Z","timestamp":1793068307851,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2002,9,1]],"date-time":"2002-09-01T00:00:00Z","timestamp":1030838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2002,9,1]],"date-time":"2002-09-01T00:00:00Z","timestamp":1030838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2002,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study presents the 2\u2010 to 10\u2010year results of 35 arthroscopically assisted combined anterior cruciate ligament and posterior cruciate ligament (ACL\/PCL) reconstructions evaluated preoperative and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT\u20101000 arthrometer testing, stress radiography, and physical examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Type of Study:<\/jats:title>\n                    <jats:p>Case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study population included 26 men and 9 women with 19 acute and 16 chronic knee injuries. Ligament injuries included 19 ACL\/PCL\/posterolateral instabilities, 9 ACL\/PCL\/medial cruciate ligament (MCL) instabilities, 6 ACL\/PCL\/posterolateral\/MCL instabilities, and 1 ACL\/PCL instability. All knees had grade III preoperative ACL\/PCL laxity and were assessed preoperatively and postoperatively with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. Arthroscopically assisted combined ACL\/PCL reconstructions were performed using the single\u2010incision endoscopic ACL technique and the single femoral tunnel\u2013single bundle transtibial tunnel PCL technique. PCLs were reconstructed with allograft Achilles tendon (in 26 cases), autograft bone\u2013patellar tendon\u2013bone (BPTB) (in 7 cases), and autograft semitendinosus\/gracilis (in 2 cases). ACLs were reconstructed with autograft BPTB (16 cases), allograft BPTB (12 cases), Achilles tendon allograft (6 cases), and autograft semitendinosus\/gracilis (1 case). MCL injuries were treated with bracing or open reconstruction. Posterolateral instability was treated with biceps femoris tendon transfer, with or without primary repair, and posterolateral capsular shift procedures as indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Postoperative physical examination revealed normal posterior drawer\/tibial step\u2010off in 16 of 35 (46%) knees. Normal Lackman and pivot\u2010shift test results were found in 33 of 35 (94%) knees. Posterolateral stability was restored to normal in 6 of 25 (24%) knees, and tighter than normal knee results were found in 19 of 25 (76%) knees evaluated with the external rotation thigh foot angle test. In this group, 30\u00b0 varus stress testing was normal in 22 of 25 (88%) knees, and grade 1 laxity was found in 3 of 25 (12%) knees. 30\u00b0 valgus stress testing was normal in 7 of 7 (100%) surgically treated MCL tears, and in 7 of 8 (87.5%) brace\u2010treated knees. Postoperative KT\u20101000 arthrometer testing mean side\u2010to\u2010side difference measurements were 2.7 mm (PCL screen), 2.6 mm (corrected posterior), and 1.0 mm (corrected anterior) measurements, a statistically significant improvement from preoperative status (\n                      <jats:italic>P<\/jats:italic>\n                      = .001). Postoperative stress radiographic side\u2010to\u2010side difference measurements measured at 90\u00b0 of knee flexion and 32 lb posteriorly directed proximal force were 0 to 3 mm in 11 of 21 (52.3%) knees, 4 to 5 mm in 5 of 21 (23.8%), and 6 to 10 mm in 4 of 21 (19%) knees. Postoperative Lysholm, Tegner, and HSS knee ligament rating scale mean values were 91.2, 5.3, and 86.8, respectively, showing a statistically significant improvement from preoperative status (\n                      <jats:italic>P<\/jats:italic>\n                      = .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Combined ACL\/PCL instabilities can be successfully treated with arthroscopic reconstruction and the appropriate collateral ligament surgery. Statistically significant improvement is noted from the preoperative condition at 2\u2010 to 10\u2010year follow\u2010up using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination. Postoperatively, these knees are not normal, but they are functionally stable. Continuing technical improvements will probably improve future results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1053\/jars.2002.35142","type":"journal-article","created":{"date-parts":[[2002,11,5]],"date-time":"2002-11-05T08:40:05Z","timestamp":1036485605000},"page":"703-714","source":"Crossref","is-referenced-by-count":276,"title":["Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2\u2010 to 10\u2010year follow\u2010up"],"prefix":"10.1002","volume":"18","author":[{"given":"Gregory C.","family":"Fanelli","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Geisinger Medical Center Danville Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J.","family":"Edson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Geisinger Medical Center Danville Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,9,1]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80424-4"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0749-8063(95)90127-2"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(96)90189-9"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198509000-00007"},{"key":"e_1_2_3_6_1","first-page":"140","article-title":"The Hospital for Special Surgery knee ligament rating form","volume":"1","author":"Windsor RE","year":"1988","journal-title":"Am J Knee Surg"},{"key":"e_1_2_3_7_1","volume-title":"Knee ligaments\u2010structure, function, injury, and repair.","author":"Daniel DM","year":"1990"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80067-2"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19930901-06"},{"key":"e_1_2_3_10_1","series-title":"Techniques in therapeutic arthroscopy.","first-page":"47","volume-title":"Arthroscopically assisted posterior cruciate ligament reconstruction using allograft tendon","author":"Malek MM","year":"1993"},{"key":"e_1_2_3_11_1","series-title":"The knee.","first-page":"791","volume-title":"Intraarticular and extra articular anterior cruciate ligament reconstruction","author":"Malek MM","year":"1994"},{"key":"e_1_2_3_12_1","series-title":"Ligament and extensor mechanism injuries of the knee.","first-page":"267","volume-title":"Combined intraarticular and extraarticular anterior cruciate ligament reconstruction","author":"Malek MM","year":"1991"},{"key":"e_1_2_3_13_1","first-page":"21","article-title":"Divergent alignment of the femoral interference screw in single incision endoscopic reconstruction of the anterior cruciate ligament","volume":"28","author":"Fanelli GC","year":"1994","journal-title":"Contemporary Orthopaedics"},{"key":"e_1_2_3_14_1","series-title":"Operative orthopaedics.","first-page":"1651","volume-title":"Repair and reconstruction of the posterior cruciate ligament","author":"Clancy WG.","year":"1988"},{"key":"e_1_2_3_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1060-1872(99)80011-2"},{"key":"e_1_2_3_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100313"},{"key":"e_1_2_3_17_1","series-title":"Posterior cruciate ligament injuries. 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