Skip to main content
Log in

Double-bundle PCL reconstruction using tibial double cross-pin fixation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The purpose of this study was to assess the clinical results of arthroscopic double-bundle posterior cruciate ligament (PCL) reconstruction using double cross-pin fixation on the tibial side. Twenty-two patients who underwent PCL reconstruction using an Achilles tendon allograft with double cross-pins for tibial fixation were evaluated. There were 19 men and 3 women with mean age 36 years (range 18–59), and the average follow-up period was 33 months (range 24–60). Preoperative and postoperative knee functions were evaluated in all patients using Lysholm knee scores, the 2000 International Knee Documentation Committee (IKDC) grades, and Tegner activity scores. Median Lysholm knee scores were 64 (50–75) preoperatively and 88 (82–96), 89.9 ± 6.5 postoperatively (P < 0.001). Median side-to-side differences, determined using Telos stress radiographs, were 11 mm (8–14) preoperatively, and 3 mm (1–7) at final follow-up visits (P < 0.01). According to KT-2000 arthrometer measurements, mean side-to-side differences were 11 mm (8–13) preoperatively and 3 mm (1–6, P < 0.01) at final follow-up visits (P < 0.01). Preoperatively the 2000 IKDC evaluation system rated all patients as abnormal or severely abnormal (C or D), and at final follow-up visits, 20 patients (88%) were rated as normal or nearly normal (A or B) and 2 patients (12%) were rated as abnormal (C). Median preinjury and preoperative Tegner scores were 7 (range 5–9) and 3 (range 2–5), respectively, and the mean postoperative Tegner score was 6 (range 3–9). There were no intraoperative or postoperative complications. Our study shows that arthroscopic double-bundle PCL reconstruction using an Achilles allograft with double cross-pins for tibial fixation provides satisfactory clinical results given a mean follow-up of 33 months. We believe that this method provides a reliable alternative technique of PCL reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ahn JH, Yang HS, Jeong WK, Koh KH (2006) Arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers: clinical results of minimum 2-year follow-up. Am J Sports Med 34:194–204. doi:10.1177/0363546505279915

    Article  PubMed  Google Scholar 

  2. Ahn JH, Yoo JC, Wang JH (2005) Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft—clinical results of a minimum 2-year follow-up. Arthroscopy 21:965–969. doi:10.1016/j.arthro.2005.05.004

    PubMed  Google Scholar 

  3. Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ (2006) The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 34:128–135. doi:10.1177/0363546505280214

    Article  PubMed  Google Scholar 

  4. Campbell RB, Jordan SS, Sekiya JK (2007) Arthroscopic tibial inlay for posterior cruciate ligament reconstruction. Arthroscopy 23(1356):e1351–1354

    Google Scholar 

  5. Chan YS, Yang SC, Chang CH, Chen AC, Yuan LJ, Hsu KY, Wang CJ (2006) Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up. Arthroscopy 22:762–770. doi:10.1016/j.arthro.2006.03.020

    Article  PubMed  Google Scholar 

  6. Chen CH, Chen WJ, Shih CH (2001) One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 17:329–332. doi:10.1053/jars.2001.21803

    PubMed  Google Scholar 

  7. Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH (2006) Arthroscopic posterior cruciate ligament reconstruction with hamstring tendon autograft: results with a minimum 4-year follow-up. Knee Surg Sports Traumatol Arthrosc 14:1045–1054. doi:10.1007/s00167-006-0113-y

    Article  CAS  PubMed  Google Scholar 

  8. Chhabra A, Kline AJ, Harner CD (2006) Single-bundle versus double-bundle posterior cruciate ligament reconstruction: scientific rationale and surgical technique. Instr Course Lect 55:497–507

    PubMed  Google Scholar 

  9. DeFrate LE, van der Ven A, Gill TJ, Li G (2004) The effect of length on the structural properties of an Achilles tendon graft as used in posterior cruciate ligament reconstruction. Am J Sports Med 32:993–997. doi:10.1177/0363546503261739

    Article  PubMed  Google Scholar 

  10. Garofalo R, Jolles BM, Moretti B, Siegrist O (2006) Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years’ follow-up. Arthroscopy 22:1331–1338 e1331

    PubMed  Google Scholar 

  11. Handy MH, Blessey PB, Kline AJ, Miller MD (2005) The graft/tunnel angles in posterior cruciate ligament reconstruction: a cadaveric comparison of two techniques for femoral tunnel placement. Arthroscopy 21:711–714. doi:10.1016/j.arthro.2005.03.011

    Article  PubMed  Google Scholar 

  12. Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL (2000) Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151

    CAS  PubMed  Google Scholar 

  13. Hatayama K, Higuchi H, Kimura M, Kobayashi Y, Asagumo H, Takagishi K (2006) A comparison of arthroscopic single- and double-bundle posterior cruciate ligament reconstruction: review of 20 cases. Am J Orthop 35:568–571

    PubMed  Google Scholar 

  14. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    CAS  PubMed  Google Scholar 

  15. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114. doi:10.1007/s001670050082

    Article  CAS  PubMed  Google Scholar 

  16. Ishibashi Y, Rudy TW, Livesay GA, Stone JD, Fu FH, Woo SL (1997) The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy 13:177–182. doi:10.1016/S0749-8063(97)90152-3

    Article  CAS  PubMed  Google Scholar 

  17. Jung YB, Jung HJ, Tae SK, Lee YS, Lee KH (2005) Reconstruction of the posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method. J Bone Joint Surg Am 87(Suppl 1):247–263. doi:10.2106/JBJS.E.00203

    Article  PubMed  Google Scholar 

  18. Kim SJ, Park IS, Cheon YM, Ryu SW (2004) Double-bundle technique: endoscopic posterior cruciate ligament reconstruction using tibialis posterior allograft. Arthroscopy 20:1090–1094. doi:10.1016/j.arthro.2004.08.002

    Article  PubMed  Google Scholar 

  19. MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22:320–328. doi:10.1016/j.arthro.2005.08.057

    Article  PubMed  Google Scholar 

  20. Margheritini 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: analysis of knee kinematics and graft in situ forces. Am J Sports Med 32:587–593. doi:10.1177/0363546503261717

    Article  PubMed  Google Scholar 

  21. Margheritini F, Rihn JA, Mauro CS, Stabile KJ, Woo SL, Harner CD (2005) Biomechanics of initial tibial fixation in posterior cruciate ligament reconstruction. Arthroscopy 21:1164–1171. doi:10.1016/j.arthro.2005.06.017

    Article  PubMed  Google Scholar 

  22. Noyes FR, Barber-Westin SD (2006) Two-strand posterior cruciate ligament reconstruction with a quadriceps tendon-patellar bone autograft: technical considerations and clinical results. Instr Course Lect 55:509–528

    PubMed  Google Scholar 

  23. Nyland J, Hester P, Caborn DN (2002) Double-bundle posterior cruciate ligament reconstruction with allograft tissue: 2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc 10:274–279

    Article  PubMed  Google Scholar 

  24. Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR (2002) Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am 84-A:938–944

    PubMed  Google Scholar 

  25. Scheffler SU, Sudkamp NP, Gockenjan A, Hoffmann RF, Weiler A (2002) Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: The impact of fixation level and fixation method under cyclic loading. Arthroscopy 18:304–315. doi:10.1053/jars.2002.30609

    Article  PubMed  Google Scholar 

  26. Seon JK, Song EK (2006) Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 22:27–32. doi:10.1016/j.arthro.2005.08.038

    Article  PubMed  Google Scholar 

  27. Shino K, Nakagawa S, Nakamura N, Matsumoto N, Toritsuka Y, Natsu-ume T (1996) Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: one-incision technique with Endobutton. Arthroscopy 12:638–642. doi:10.1016/S0749-8063(96)90207-8

    Article  CAS  PubMed  Google Scholar 

  28. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198(9):43–49

    PubMed  Google Scholar 

  29. Weimann A, Wolfert A, Zantop T, Eggers AK, Raschke M, Petersen W (2007) Reducing the “killer turn” in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture. Arthroscopy 23:1104–1111. doi:10.1016/j.arthro.2007.04.014

    Article  PubMed  Google Scholar 

  30. Weimann A, Zantop T, Rummler M, Hassenpflug J, Petersen W (2003) Primary stability of bone-patellar tendon-bone graft fixation with biodegradable pins. Arthroscopy 19:1097–1102. doi:10.1016/j.arthro.2003.10.023

    Article  PubMed  Google Scholar 

  31. Wiley WB, Askew MJ, Melby A III, Noe DA (2006) Kinematics of the posterior cruciate ligament/posterolateral corner-injured knee after reconstruction by single- and double-bundle intra-articular grafts. Am J Sports Med 34:741–748. doi:10.1177/0363546505282615

    Article  PubMed  Google Scholar 

  32. Yoon KH, Bae DK, Song SJ, Lim CT (2005) Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft. Arthroscopy 21:1436–1442. doi:10.1016/j.arthro.2005.09.002

    Article  PubMed  Google Scholar 

  33. Zantop T, Lenschow S, Lemburg T, Weimann A, Petersen W (2004) Soft-tissue graft fixation in posterior cruciate ligament reconstruction: evaluation of the effect of tibial insertion site on joint kinematics and in situ forces using a robotic/UFS testing system. Arch Orthop Trauma Surg 124:614–620. doi:10.1007/s00402-004-0741-y

    Article  PubMed  Google Scholar 

  34. Zantop T, Ruemmler M, Welbers B, Langer M, Weimann A, Petersen W (2005) Cyclic loading comparison between biodegradable interference screw fixation and biodegradable double cross-pin fixation of human bone-patellar tendon-bone grafts. Arthroscopy 21:934–941. doi:10.1016/j.arthro.2005.05.022

    Article  PubMed  Google Scholar 

  35. Zantop T, Weimann A, Rummler M, Hassenpflug J, Petersen W (2004) Initial fixation strength of two bioabsorbable pins for the fixation of hamstring grafts compared to interference screw fixation: single cycle and cyclic loading. Am J Sports Med 32:641–649. doi:10.1177/0095399703258616

    Article  PubMed  Google Scholar 

  36. Zhao J, He Y, Wang J (2007) Double-bundle anterior cruciate ligament reconstruction: four versus eight strands of hamstring tendon graft. Arthroscopy 23:766–770. doi:10.1016/j.arthro.2007.01.022

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ji Hoon Bae.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lim, H.C., Bae, J.H., Wang, J.H. et al. Double-bundle PCL reconstruction using tibial double cross-pin fixation. Knee Surg Sports Traumatol Arthrosc 18, 117–122 (2010). https://doi.org/10.1007/s00167-009-0812-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0812-2

Keywords

Navigation