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Is the All-arthroscopic Tibial Inlay Double-bundle PCL Reconstruction a Viable Option in Multiligament Knee Injuries?

  • Symposium: Management of the Dislocated Knee
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

All-arthroscopic tibial inlay double-bundle (DB) posterior cruciate ligament (PCL) reconstruction avoids an open dissection and the “killer turn” while maintaining the advantage of an anatomic graft. However, clinical data on the viability of this surgical technique in multiligamentous knee injuries are lacking.

Questions/purposes

At greater than 2 years of followup, we evaluated (1) validated outcomes scores; (2) range of motion; and (3) side-to-side stability on PCL stress radiographs of a small group of patients who underwent all-arthroscopic tibial inlay DB PCL reconstruction in multiligamentous knee injuries, either shortly after injury or late.

Methods

All patients sustaining an operative multiligamentous knee injury between August 2007 and March 2009 underwent PCL reconstruction with the all-arthroscopic tibial inlay DB PCL reconstruction. Twelve patients sustained such injuries and were reconstructed during the study period and all 12 returned for followup with a minimum of 2 years (mean 3 ± 0.8 years). There were nine males and three females, with a mean age of 30 years; four patients had a subacute reconstruction (≥ 3 weeks, but < 3 months), and eight patients had chronic reconstructions (> 3 months). Mean time from injury to PCL reconstruction was 7 ± 12 months. Demographics, ROM, outcome scores (Lysholm and International Knee Documentation Committee [IKDC] scores), and PCL stress views were obtained.

Results

At final followup, mean Lysholm and IKDC subjective scores were 79 ± 16 and 72 ± 19, respectively. IKDC objective scores included eight nearly normal knees, three abnormal knees, and one severely abnormal knee. Mean flexion and extension losses compared with the contralateral were 10 ± 9 and 1 ± 2, respectively. Mean ± SD final side-to-side difference on PCL stress radiographs was 5 ± 3 mm.

Conclusions

The clinical and radiographic results of the all-arthroscopic tibial inlay DB PCL reconstruction appear comparable to the same technique in isolated PCL injuries and, based on similar published case series, comparable to results of multiligamentous knee reconstructions using other PCL reconstruction techniques.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Tom Cichonski for his contributions to manuscript production.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI, 48106, USA

    Alexander E. Weber MD, Benjamin Bissell MD, Edward M. Wojtys MD & Jon K. Sekiya MD

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  1. Alexander E. Weber MD
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  2. Benjamin Bissell MD
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  3. Edward M. Wojtys MD
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  4. Jon K. Sekiya MD
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Corresponding author

Correspondence to Jon K. Sekiya MD.

Additional information

One of the authors (JKS) certifies that he has a signed agreement with a commercial interest related to this study (Arthrex, Inc, Naples, FL, USA) that does not in any way limit publication of any and all data generated for the study or delay publication for any reason. One of the authors certifies that he (JKS), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Arthrex, Inc.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Weber, A.E., Bissell, B., Wojtys, E.M. et al. Is the All-arthroscopic Tibial Inlay Double-bundle PCL Reconstruction a Viable Option in Multiligament Knee Injuries?. Clin Orthop Relat Res 472, 2667–2679 (2014). https://doi.org/10.1007/s11999-014-3796-2

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