Posterior Cruciate Ligament Replacement with a Two-Strand Quadriceps Tendon-Patellar Bone Autograft and a Tibial Inlay Technique

Abstract

Complete ruptures of the posterior cruciate ligament alter knee kinematics and may result in functional limitations with sports and daily activities. We prospectively evaluated the functional results and knee stability after posterior cruciate ligament replacement with use of a two-strand quadriceps tendon-patellar bone autograft and a tibial inlay technique. Nineteen patients were followed for a mean of thirty-five months postoperatively. All had a chronic knee injury, and eight had additional ligament reconstructions. The results were measured with stress radiography, arthrometric testing, and two validated knee-rating instruments. Eighteen patients rated the knee condition as improved. Before surgery, eleven patients had pain with daily activities, but only one had such pain at the time of the latest follow-up. Significant improvements were noted for pain, swelling, giving-way, walking, climbing stairs, squatting, running, jumping, and twisting and turning (all p < or = 0.05). Eleven patients returned to low-impact sports, and two patients were able to participate in strenuous sports without problems. At the time of the latest follow-up, stress radiography revealed that fourteen knees had < or =5 mm of increased posterior tibial translation between the reconstructed and the contralateral side, three knees had 6 to 10 mm, and two knees had >10 mm. No knee had an infection, permanent limitation of knee motion, or patellar fracture. Posterior cruciate ligament replacement produced reasonable subjective, functional, and objective results in this group of complex, chronic knee injuries. The tibial inlay approach was useful in nine revisions in which prior tibial tunnels had to be avoided.