Reconstruction of Isolated Posterior Cruciate Ligament Injuries: A Clinical Comparison of the Transtibial and Tibial Inlay Techniques

Abstract

To compare the clinical and stress radiologic results of posterior cruciate ligament (PCL) reconstruction using the transtibial tunnel technique and tibial inlay technique. Retrospective case series. Patients who had received isolated PCL reconstruction without combined ligamentous reconstruction and who also had a minimum 2-year follow-up were included in the study. The transtibial tunnel technique with quadrupled hamstring autograft group (group A) was composed of 21 knees and the tibial inlay technique with bone-patellar tendon-bone autograft group (group B) of 22 knees. We compared the 2 groups with regard to Lysholm knee scores, Tegner activity scores, posterior draw tests at 90 degrees flexion, and radiologic stability of the knees by using a Telos device (Austin & Associates, Fallston, MD). The Lysholm knee scores showed a significant improvement from 55.3 points preoperatively to 91.5 at the final follow-up in group A and from 51.7 preoperatively to 93.5 at the final follow-up in group B. However, intergroup differences were not significantly different (P = .259). Activity levels, as determined using the Tegner scoring system, also showed significant improvements at the final follow-up in both groups, but again, this was not significantly different (P = .264). On the posterior drawer test at the final follow-up, normal or grade I laxity was observed in 19 patients in group A and in 20 patients in group B. By instrumented posterior laxity testing, mean side-to-side differences were significantly improved from 12.3 mm preoperatively to 3.7 mm at the final follow-up in group A and from 11.0 mm to 3.3 mm in group B, but without significance (P = .607). The transtibial tunnel and tibial inlay techniques produced relatively good clinical and stress radiologic results, and no significant differences were identified between the 2 techniques. Therefore, we suggest that the transtibial tunnel and tibial inlay techniques are both satisfactory PCL reconstruction procedures. Level III.