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Reconstruction of the Posterior Cruciate Ligament with a Mid-Third Patellar Tendon Graft with Use of a Modified Tibial Inlay Method

¹ Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 224-1, Heukseokdong, Dongjak-ku, 156-070, Seoul, South Korea. E-mail address for Y.-B. Jung: jungyb2000{at}paran.com

Investigation performed at the Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, Seoul, South Korea

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 1878-1883, September 2004

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure.

METHODS:

Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up.

RESULTS:

The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 ± 1.9 mm preoperatively to 3.4 ± 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 ± 2.1 mm preoperatively to 1.8 ± 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 ± 6.8 to 92.5 ± 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft.

CONCLUSIONS:

Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery.

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