Note: To access the videos accompanying this report, visit the September issue of Arthroscopy at www.arthroscopyjournal.org.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic Review With Video IllustrationsOpen Tibial Inlay Versus Arthroscopic Transtibial Posterior Cruciate Ligament Reconstructions
Section snippets
Methods
A PubMed search was performed with the terms “posterior cruciate,” “tibial inlay,” and “tibial tunnel” that identified 31 publications. We identified 2 Level III clinical studies and 6 biomechanical studies comparing the results of open tibial inlay and arthroscopic transtibial PCL reconstruction. “Related articles” to these publications were also searched on PubMed. The references used in these publications were searched to identify more studies on PCL reconstruction techniques. An additional
Biomechanical Studies
Bergfeld et al.8 published the first biomechanical study comparing PCL reconstruction by open inlay and arthroscopic transtibial techniques in cadaveric knees, in 2001. The reconstruction was performed with central one-third bone–patellar tendon–bone (BPTB) grafts. Grafts were pre-tensioned with 156 N of anterior tibial force. The authors performed 72 cycles of repetitive loading with a 150-N anteroposterior (AP) force with the knee flexed at 90° and in neutral tibial rotation. Knee laxity was
Is There an Advantage in AP Stability of Tibial Inlay Reconstructions Compared With Transtibial Tunnel Reconstructions?
McAllister et al.10 and Margheritini et al.12 found no difference in AP laxity between the tibial inlay and transtibial tunnel reconstruction groups, whereas Bergfeld et al.8 found better AP stability after open inlay reconstruction. The results of Hiraga et al.13 varied with the type of the graft and method of graft fixation. They did not find a significant difference between open inlay and tibial tunnel reconstruction with similar graft types. However, a significant difference was found when
Conclusions
Biomechanical studies show that there may be no difference in AP laxity and graft forces between open inlay and tibial tunnel reconstruction techniques at time 0. The graft loading protocol may likely have an effect on graft degradation and failure at the killer turn with transtibial tunnel reconstruction. However, the advantage of the open inlay or tibial tunnel reconstruction technique remains uncertain in the setting of conflicting biomechanical studies and notable limitations in clinical
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Cited by (48)
Onlay Technique for Posterior Cruciate Ligament Reconstruction: The Paccola's Technique
2023, Arthroscopy TechniquesPosterior cruciate ligament tibial inlay
2022, Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine, Third EditionNo difference in subjective and objective clinical outcomes between arthroscopic transtibial and open inlay posterior cruciate ligament reconstruction techniques in the treatment of multi-ligamentous knee injuries
2021, KneeCitation Excerpt :Compared with the previous studies, this study has the following advantages: (1) a comprehensive preoperative assessment was conducted for the patients with injuries, and the patients with combined Grade I PLC and MCL injuries were given a repair and a reconstruction, thus reducing the negative impact of the combined injuries on the efficacy of the PCL surgery; (2) an analysis of statistical effectiveness was conducted such that the statistical results had more explanatory power; (3) KT-1000 and Telos stress devices were used to assess the posterior stability of the knee, thus improving the reliability of the results; and (4) all of the grafts for PCL reconstruction were allogeneic tendon grafts, which ensured the identity of the grafts and reduced the deviation caused by different grafts. The advantages of the transtibial technique include fewer complications, easy patient positioning, and satisfactory clinical outcomes, while the advantages of the inlay technique are its biomechanical superiority and the avoidance of the ‘killer turn’ effect [5,9,10,24]. Biomechanical studies suggested that the fundamental difference between the inlay and transtibial techniques is the tibial insertion.
Posterior Cruciate Ligament
2020, Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best OutcomesPosterior Cruciate Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes
2017, Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical OutcomesOutcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach
2023, Indian Journal of Orthopaedics
J.K.S. receives royalties from Arthrex and OrthoDynamix, is a paid consultant for Arthrex, and holds stock in OrthoDynamix.