Clin Orthop Surg.  2010 Jun;2(2):76-84. 10.4055/cios.2010.2.2.76.

A Comparison of Arthroscopically Assisted Single and Double Bundle Tibial Inlay Reconstruction for Isolated Posterior Cruciate Ligament Injury

• Shon OJ
• Lee DC
• Park CH
• Kim WH
• Jung KA

• KMID: 1719333
• DOI: http://doi.org/10.4055/cios.2010.2.2.76

Abstract

BACKGROUND
This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury.
METHODS
This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively.
RESULTS
The Lysholm knee scores in groups A and B increased from an average of 43.3 +/- 7.04 and 44.7 +/- 5.02 preoperatively to 88.1 +/- 7.32 and 88.7 +/- 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 +/- 1.60 mm at 30degrees of flexion and 9.8 +/- 1.70 mm at 90degrees of flexion were improved to 2.8 +/- 1.19 mm and 3.0 +/- 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 +/- 1.50 mm at 30degrees of flexion and 10.7 +/- 1.60 mm at 90degrees of flexion improved to 2.7 +/- 1.15 mm and 2.6 +/- 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups.
CONCLUSIONS
Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.

Keyword

Posterior cruciate ligament; Reconstruction; Tibial inlay; Single bundle; Double bundle

MeSH Terms

Adolescent
Adult
*Arthroscopy
Female
Humans
Male
Middle Aged
Orthopedic Procedures/*methods
Posterior Cruciate Ligament/*injuries/*surgery
Reconstructive Surgical Procedures/methods
Tendons/transplantation
Tibia/*surgery
Young Adult

Figure

• 

  Fig. 1 Thirty-two year old man who was involved in a motor vehicle accident. Single bundle posterior cruciate ligament reconstruction was performed using the tibial inlay technique. (A) Stress view, preoperative and follow-up (F/U) 76 months. (B) Posterior stress roentgenography using the Telos stress device at 30° of flexion showed grade 1 posterior instability at both the preoperative and follow-up 76 months. (C) Posterior stress roentgenography using the Telos stress device at 90° of flexion showed grade 1 posterior instability at both the preoperative and follow-up 76 months.

• 

  Fig. 2 Forty-six year old man who was involved in a motor vehicle accident. A double bundle posterior cruciate ligament reconstruction was performed using the tibial inlay technique. (A) Stress view, preoperative and follow-up 60 months. (B) Posterior stress roentgenography using the Telos stress device at 30° of flexion showed grade 1 posterior instability both preoperatively and at the 60 months follow-up. (C) Posterior stress roentgenography using the Telos stress device at 90° of flexion showed grade 1 posterior instability preoperatively and at the 60 months follow-up.

• 

  Fig. 3 (A) The illustration shows posterior view of a single bundle tibial inlay posterior cruciate ligament reconstruction. (B) Lateral view of femoral tunnel position in the medial femoral condyle. The center of a 10 mm diameter femoral tunnel was placed 7 mm proximal to the margin of the articular cartilage of the medial femoral condyle at 11 o'clock in the left knee joint, or at 1 o'clock in the right knee joint.

• 

  Fig. 4 (A) The illustration shows the posterior view of double bundle tibial inlay posterior cruciate ligament reconstructions. (B) Lateral view of the femoral tunnel position in the medial femoral condyle. The center for the 9 mm diameter anterolateral femoral tunnel was placed 7 mm proximal to the margin of the articular cartilage of the medial femoral condyle at the 11 o'clock position in the left knee joint, or at the 1 o'clock position in the right knee joint, and the center for 8 mm diameter posteromedial femoral tunnel, at 9 mm proximal to the margin of the articular cartilage at the 3 o'clock position on the right (9 o'clock on left). The distance between femoral tunnels must be > 4 mm to avoid tunnel bridge collapse.

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