Arthroscopic Posterior Cruciate Ligament Reconstruction with Two Graft Tendons by Combined Femoral Dual Tunnel and Modified Tibial Inlay Method

ABSTRACT

From July 1997, Authors have reconstructed the posterior cruciate ligament(PCL) deficient knees with two graft tendons; an autogenous bone-patellar tendon-bone (BPTB) and a semitendinosus tendon. At Femoral side, the two graft tendons were fixed through the two tunnels which were made at the site of foot print of PCL. The original site of anterolateral bundle of the PCL was reconstructe(I with the autogenous BPTB and the original site of posteromedial bundle with the semitendinosus tendon. At tibial side, the two graft tendons were fixed by modified inlay technique; the BPTB was fixed with a cancellous screw and the semitendinosus tendon with staples. Seven cases were followed up more than six months and authors evaluated the results with the KT-1000TM arthrometer and the posterior stress radiographs by Telos stress dcvice and compared the resu]t of injured knee with the uninjured side of each patient. The results of manual maximal displacement test with arthrometer were less than 4 mm in six patients and 8 rnm in one patient at last follow up. The average distance of posterior displacement on stress radiographs was 10.3 mm preoperatively and 2.7 mm at final follow up period. Six of the seven patients had a good stability on posterior stress radiographs compared with the uninjured side. One patient had posterior knee insta- bility on stress radiographs due to loosening of the grafted tendon and retightening of the grafted tendon was performed through the posterior approach to the proximal tibia. The original idea of femoral dual tunnel method in PCL reconstructiori is to reconstruct the PCL more anatomically and the modified tibial inlay technique can solve the problern of graft tendon abrasion at the posterior opening of the tibial tunnel in transtibial tunnel method and retightening of the loose grafted tendon is simple than the other methods of PCL reconstruction. Authors expect that this combined femoral dual tun- nel and modified tibial inlay method may improve the quality of the outcome of the arthroscopic PCL reconstruction.