Transtibial Versus Tibial Inlay Techniques for Posterior Cruciate Ligament Reconstruction: Long-term Follow-up Study

• Published in: The American journal of sports medicine 2014-12, Vol.42 (12), p.2964-2971
• Main Authors: Song, Eun-Kyoo, Park, Hyeong-Won, Ahn, Yeong-Seub, Seon, Jong-Keun
• Format: Article
• Language: English
• Subjects: Adult; Arthritis; Arthroscopy; Clinical outcomes; Comparative analysis; Female; Femur - surgery; Follow-Up Studies; Humans; Joint Instability - diagnostic imaging; Joint Instability - surgery; Knee Joint - diagnostic imaging; Knee Joint - surgery; Ligaments; Lysholm Knee Score; Male; Orthopedic Procedures - methods; Orthopedics; Osteoarthritis, Knee - etiology; Posterior Cruciate Ligament - surgery; Radiography; Skin & tissue grafts; Tendons - transplantation; Tibia - surgery; Young Adult
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546514550982

Background: The most common technique for posterior cruciate ligament (PCL) reconstruction is transtibial or tibial inlay. However, few studies have reported long-term outcome comparisons between the 2 techniques. Hypothesis: Tibial inlay PCL reconstruction with patellar tendon autograft will exhibit better clinical and radiographic outcomes than transtibial PCL reconstruction with hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 66 patients (66 knees) treated with PCL reconstruction for chronic injuries constituted the study cohort. Patients were divided into 2 groups: transtibial with hamstring (36 patients) and tibial inlay with patellar tendon (30 patients). The mean time from injury to reconstruction was 12.2 months (range, 2-60 months), and the mean follow-up was 148 months (range, 98-196 months). Outcomes were measured by use of Lysholm knee scores, Tegner activity scores, return to preinjury sports activity, posterior drawer test, laxity test with a Telos device, and development of osteoarthritis. Results: The preoperative mean Lysholm knee score was 59.9 (range, 37-70) in the transtibial group and 54.5 (range, 22-76) in the tibial inlay group, improving postoperatively to 89.9 (range, 74-100) and 92.1 (range, 80-100), respectively. The mean Tegner activity scores increased from 2.5 (range, 2-5) to 5.9 (range, 4-7) in the transtibial group and 2.3 (range, 2-4) to 6.0 (range, 3-8) in the tibial inlay group. Twenty-one patients (58.3%) in the transtibial group and 19 patients (63.3%) in the tibial inlay group were able to return to preinjury sports activity. In the posterior drawer test, 6 patients in the transtibial group and 4 patients in the tibial inlay group showed grade II laxity. The mean side-to-side difference was 10.1 mm (range, 7-12 mm) in the transtibial group and 10.4 mm (range, 9-13 mm) in the tibial inlay group, improving postoperatively to 4.1 mm (range, 0-8 mm) and 4.2 mm (range, 1-8 mm), respectively. There was significant improvement between preoperative and final follow-up values. However, there were no significant differences between the 2 groups in final follow-up outcomes. Final follow-up radiographs showed that 6 patients (16.7%) in the transtibial group and 3 patients (10.0%) in the tibial inlay group were rated grade C according to International Knee Documentation Committee guidelines. Conclusion: Clinical and radiographic outcomes between the 2 PCL reconstruction techniques were com