Establishment of tibial tunnel via a posterior-anterior approach for all-inside posterior cruciate ligament reconstruction: short-term outcomes

Abstract

Objective To introduce a new posterior-anterior approach used to establish tibial tunnel for all-inside posterior cruciate ligament (PCL) reconstruction and evaluate its short-term therapeutic effects. Methods We retrospectively analysed the 15 patients (15 knees) with PCL injury who had been treated at Department of Orthopaedics, Zhejiang Provincial People's Hospital from January 2017 to January 2018. They were 9 men and 6 women, with a mean age of 46.3 years (from 23 to 60 years). Of them, 8 left and 7 right sides were injured. The intervals from injury to surgery averaged 33.6 days (from 4 to 120 days). Their injury was complicated with medial meniscus tear in 3 cases, lateral meniscus tear in one case, lesion of medial col-lateral ligament in 2 cases and lesion of lateral medial collateral ligament in one case. After preoperative physical examination and MRI confirmed complete PLC tear in all of them, they were treated by arthroscopic all-inside PCL reconstruction in which a new posterior-anterior approach was used to establish the tibial tunnel. Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were used preoperatively and postop-eratively to evaluate the knee functions. Results Their follow-ups averaged 8.3 months (from 6 to 12 months). Operation time averaged 55 minutes (from 45 to 70 minutes). All the patients got rid of the knee instability after surgery. All their posterior drawer tests and sag signs turned to be negative. At the final fol-low-up, their range of motion of the knee ranged from 110° to 130° (average, 118°); their average IKDC score was 88.1±3.3 (from 82 to 93), significantly higher than the preoperative value (52.3±2.1) (P<0.05); their average Lysholm score was 90.6±3.1 (from 84 to 96), significantly higher than the preoperative value (43.1±2.3) (P<0.05). Conclusions This new method can avoid neurovascular damage and overcome the killer turn because it provides adequate exposure of the tibial PCL footprint and accurate placement of the tibial tunnel. It is also very convenient because the new posterior-anterior approach can be used to establish the tibial tunnel in all-inside PCL reconstruction without special tools like tibial PCL guide and retrograde drill. Its short-term clinical results have proved to be satisfactory. Key words: Posterior cruciate ligament; Arthroscopy; Wounds and injuries; Tibial tunnel