Purpose: Posterior cruciate ligament (PCL) injuries have potential for intrinsic healing and
several magnetic resonance imaging studies have reported that the PCL healed with
continuity but also with residual laxity. The goal of our study was to introduce a
new method and investigate the outcome of tensioning of the remnant PCL and reconstruction
of the anterolateral (AL) bundle of the PCL using modified inlay technique. Type of Study: Therapeutic study. Methods: Forty-nine patients who underwent tensioning of the remnant PCL and reconstruction
of the AL bundle of the PCL were evaluated 45.7 months (range, 24 to 78 months) on
average after surgery. Tensioning was performed by distal transfer of the tibial attachment.
The AL bundle of the PCL was reconstructed with 4 bundles of hamstring tendon (34
cases), bone–patellar tendon–bone graft (7 cases), or Achilles tendon allograft (8
cases), arthroscopically at the femoral tunnel and by the modified inlay technique
through a posteromedial approach in the supine position. In 35 patients who had a
combined posterolateral rotatory instability, the posterolateral corner reconstruction
was performed. Stability was assessed by stress radiographs with the Telos device
and maximal manual testing with KT-1000 arthrometer. The clinical results were assessed
by IKDC and OAK scores. Physical examination was performed using the posterior drawer
test, varus stress test, posterolateral drawer test, and dial test in 30° and 90°
flexion. Results: The average side-to-side difference of posterior tibial translation on posterior
stress radiographs decreased from 10.4 ± 2.1 mm to 2.2 ± 1.0 mm. The average side-to-side
difference in maximal manual test with the KT-1000 arthrometer also decreased from
8.2 ± 1.5 mm to 1.9 ± 1.0 mm. The final IKDC score was A in 10 (20.4%), B in 33 (67.3%),
and C in 6 (12.2%) patients. The average OAK score improved from 63.3 ± 8.3 to 91
± 7.3. Conclusions: Good clinical results and very good posterior stability were achieved with tensioning
of the remnant PCL and reconstruction of the AL bundle using the modified inlay technique
in chronic PCL injuries. With this technique, the surgeon can operate without changing
the patient’s position during surgery. Level of Evidence: Level IV, therapeutic study.
Key Words
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Footnotes
Note: To access the supplementary table accompanying this report, visit the March issue of Arthroscopy at www.arthroscopyjournal.org
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© 2006 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
