Advertisement

International Orthopaedics

, Volume 38, Issue 11, pp 2363–2368 | Cite as

The biomechanical characteristics of arthroscopic tibial inlay techniques for posterior cruciate ligament reconstruction: in vitro comparison of tibial graft tunnel placement

  • Karl Peter Benedetto
  • Thomas Hoffelner
  • Michael Osti
Original Paper

Abstract

Purpose

The hypothesis of the present study was that the biomechanical properties of arthroscopic tibial inlay procedures depend on tibial graft bone block position.

Methods

Five paired fresh-frozen human cadaveric knee specimens were randomized to a reconstruction with quadriceps tendon placing the replicated footprint either to the more proximal margin of the remnants of the anatomical PCL fibrous attachments (group A) or to the distal margin of the anatomical PCL fibrous attachments at the edge of the posterior tibial facet to the posterior tibial cortex in level with the previous physis line (group B). The relative graft-tibia motions, post cycling pull-out failure load and failure properties of the tibia-graft fixation were measured. Cyclic displacement at 5, 500 and 1,000 cycles, stiffness and yield strength were calculated.

Results

The cyclic displacement at 5, 500 and 1,000 cycles measured consistently more in group A without statistically significant difference (4.11 ± 1.37, 7.73 ± 2.73 and 8.18 ± 2.75 mm versus 2.81 ± 1.33, 6.01 ± 2.37 and 6.46 ± 2.37 mm). Mean ultimate load to failure (564.6 ± 212.3) and yield strength (500.2 ± 185.9 N) were significantly higher in group B (p < 0.05).

Conclusion

Replicating the anatomical PCL footprint at the posterior edge of the posterior tibial facet yields higher pull-out strength and less cycling loading displacement compared to a tunnel position at the centre of the posterior tibial facet.

Keywords

PCL reconstruction All-inside technique Tibial tunnel position Biomechanics 

Notes

Acknowledgments

The authors thank Arthrex Inc. for assistance in providing laboratory materials and equipment used for this project.

References

  1. 1.
    Cooper DE, Stewart D (2004) Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation. Am J Sports Med 32:346–360PubMedCrossRefGoogle Scholar
  2. 2.
    Tompkins M, Keller TC, Milewski MD, Gaskin CM, Brockmeier SF, Hart JM, Miller MD (2013) Anatomic femoral tunnels in posterior cruciate ligament reconstruction. inside-out versus outside-in drilling. Am J Sports Med 41:43–50PubMedCrossRefGoogle Scholar
  3. 3.
    Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL (2012) Posterior cruciate ligament. anatomy, biomechanics and outcomes. Am J Sports Med 41:222–231CrossRefGoogle Scholar
  4. 4.
    Boutefnouchet T, Bentayeb M, Qadri Q, Ali S (2013) Long-term outcomes following single-bundle transtibial arthroscopic posterior cruciate ligament reconstruction. Int Orthop 37:337–343PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Mannor DA, Shearn JT, Grood ES, Noyes FR, Levy MS (2000) Two-bundle posterior cruciate ligament reconstruction. an in vitro analysis of graft placement and tension. Am J Sports Med 28:833–845PubMedGoogle Scholar
  6. 6.
    Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR (2003) The effect of femoral tunnel position on graft forces during inlay posterior cruciate ligament reconstruction. Am J Sports Med 31:667–672PubMedGoogle Scholar
  7. 7.
    Amis AA, Gupte CM, Bull AMJ, Edwards A (2006) Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 14:257–263PubMedCrossRefGoogle Scholar
  8. 8.
    Moorman CT 3rd, Murphy Zane MS, Bansai S, Cina SJ, Wickiewicz TL, Warren RF, Kaseta MK (2008) Tibial insertion of the posterior cruciate ligament: a sagittal plane analysis using gross, histologic and radiographic methods. Arthroscopy 24:269–275PubMedCrossRefGoogle Scholar
  9. 9.
    Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792PubMedCrossRefGoogle Scholar
  10. 10.
    Bergfeld JA, McAllister DR, Parker RD, Valdevit ADC, Kambic HE (2001) A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med 29:129–136PubMedGoogle Scholar
  11. 11.
    Bergfeld JA, Graham SM, Parker RD, Valdevit ADC, Kambic HE (2005) A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double bundle tibial inlay techniques. Am J Sports Med 3:976–981CrossRefGoogle Scholar
  12. 12.
    Davis DK, Goltz DH, Fithian DC, D’Lima D (2006) Anatomical posterior cruciate ligament reconstruction. Am J Sports Med 34:1126–1133PubMedCrossRefGoogle Scholar
  13. 13.
    Margheretini F, Mauro CS, Rihn JA, Stabile KJ, Woo SL, Harner CD (2004) Biomechanical comparison of tibial inlay versus transtibial techniques for posterior cruciate ligament reconstruction. Am J Sports Med 32:587–593CrossRefGoogle Scholar
  14. 14.
    Markolf KL, Zemanovic JR, McAllister DR (2002) Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. J Bone Joint Surg Am 84:518–524PubMedCrossRefGoogle Scholar
  15. 15.
    Chen C, Chen W, Shih C, Chou S (2004) Arthroscopic posterior ligament reconstruction with quadriceps tendon autograft. minimal 3 years follow-up. Am J Sports Med 32:361–368PubMedCrossRefGoogle Scholar
  16. 16.
    Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF (2013) Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. Am J Sports Med 41:35–42PubMedCrossRefGoogle Scholar
  17. 17.
    Noyes FR, Medvechy MJ, Bhargava M (2003) Technical note. Arthroscopically assisted quadriceps double bundle tibial inlay posterior cruciate ligament reconstruction: an analysis of techniques and a safe operative approach to the popliteal fossa. Arthroscopy 19:894–905PubMedCrossRefGoogle Scholar
  18. 18.
    Campbell RB, Torrie A, Hecker A, Sekiya JK (2007) Comparison of tibial graft fixation between simulated arthroscopic and open inlay techniques for posterior cruciate ligament reconstruction. Am J Sports Med 35:1731–1738PubMedCrossRefGoogle Scholar
  19. 19.
    Markolf K, Davies M, Zoric B, McAllister D (2003) Effects of bone block position and orientation within the tibial tunnel for posterior cruciate ligament reconstructions. a cyclic loading study of bone-patellar tendon-bone allografts. Am J Sports Med 31:673–679PubMedGoogle Scholar
  20. 20.
    Kim Y, Lee CA, Matave MJ (2011) Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction. a systematic review. Am J Sports Med 39:425–434PubMedCrossRefGoogle Scholar
  21. 21.
    Panchal HB, Sekiya JK (2011) Open tibial versus arthroscopic transtibial posterior cruciate ligament reconstructions. Arthroscopy 27:1289–1295PubMedCrossRefGoogle Scholar
  22. 22.
    Burns WC, Draganich LF, Pyevich M, Reider B (1995) The effect of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. Am J Sports Med 23:424–430PubMedCrossRefGoogle Scholar
  23. 23.
    Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T (2006) Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction. Biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 34:456–463PubMedCrossRefGoogle Scholar
  24. 24.
    Galloway MT, Grood ES, Mehalik JN, Levy M, Saddler SC, Noyes FR (1996) Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement. Am J Sports Med 24:437–445PubMedCrossRefGoogle Scholar
  25. 25.
    Osti M, Tschann P, Künzel KH, Benedetto KP (2012) Anatomic characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. Am J Sports Med 40:1558–1563PubMedCrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Karl Peter Benedetto
    • 1
  • Thomas Hoffelner
    • 2
  • Michael Osti
    • 1
  1. 1.Department of Trauma Surgery and Sports TraumatologyAcademic Hospital FeldkirchFeldkirchAustria
  2. 2.Department of Trauma Surgery and Sports TraumatologyParacelsus Medical University SalzburgSalzburgAustria

Personalised recommendations