Abstract:

BACKGROUND: Literatures report that double-bundle reconstruction is a better choice for posterior cruciate ligament (PCL), but Tibial-inlay technique exhibits no significant difference.
OBJECTIVE: To evaluate the effect of Tibial-inlay technique used in the PCL reconstruction with allograft tendons.
METHODS: Thirty-one patients with PCL rupture were verified by arthroscopy in the Department of Orthopaedics, at the Affiliated Hospital of Chengde Medical College between February 2006 and May 2008, including 14 knees caused by traffic accident injury, 9 knees by crashing, and 8 knees by athletic injury. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under arthroscopy. During surgery, the remnants of the original PCL were retained as much as possible, PCL femoral tunnel was prepared. By using of allogeneic patella tendon with bone block at both ends or achilles tendon allograft with bone block at one side, the lateral bone block was chipped into trapezoidal block at a width of 1.0-1.5 cm and a length of    2 cm, that is, in addition to relying on friction force to fix between bone groove and bone graft, it can also generate compressive stress and increase its stability. The PCL tibial attached point was stripped, the trapezoid bone groove was prepared according to the size of bone block at the insertion site, and allogeneic bone block was embedded into bone groove, then the other end was introduced to femoral tunnel using pulling wire through the joint, after tensed at anterior drawer site, the extrusion screw was twisted forward to fix the tendon or bone. Before operation and during follow-ups, the posterior drawer test knee instability, joint activity, Lysholm knee function scores were recorded. 
RESULTS AND CONCLUSION: No severe complications, such as vascular nerve injury, rejection or infection, occurred in early stage after operations in 31 patients. All of them were followed up for 12-24 months. Posterior drawer test of all the subjects were above 2+ before operation, of which, 3+ and 4+ were 84%; the posterior drawer test results were as the following after operation: 4 cases of 0+ (normal), 17 cases of 1+, 9 cases of 2+ and 1 case of 3+, which shows the improvement of retroposition (P < 0. 05); Lysholm score was remarkably improved at follow-up compared with preoperation (P < 0.05), and there were significant improvements in the joint range of motion (P < 0.05). The reconstruction of PCL by Tibial-inlay technique with allograft tendons has advantages of minimal trauma in surgery, reliable fixation and satisfactory outcome.