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Document Title: Bergfeld-AJSM-Mar01.shtml
Article Title: A Biomechanical Comparison of Posterior Cruciate Ligament Reconstruction Techniques
Authors: John A. Bergfeld, MD, David R. McAllister, MD, Richard D. Parker, MD, Antonio D. C. Valdevit, MSc and Helen E. Kambic, MS
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: Mar/Apr 2001
Volume 29, Number 2, pages 129-136
(Figures included. Reference-denoting numbers appear in the same point size as the document text.)
Comments: The authors describe the anatomic tibial inlay technique of PCL reconstruction, which more closely replicates the anatomic insertion site of the PCL at the rear of the tibia. The method avoids the excessive bending of the graft at the mouth of the tibial bone tunnel, a problem typical of the traditional tunnel-based PCL reconstruction technique. Although this study focuses on the biomechanics of the single-bundle PCL graft, the authors quote previous studies by Race and Harner, which found that the double-bundle PCL-reconstruction method is superior in restoring both normal knee movement and ligament tensile loadings.
ABSTRACT
Most posterior cruciate ligament reconstruction techniques use both tibial and femoral bone tunnels for graft placement. Because of the acute angle the graft must make to gain entrance into the tibial tunnel, abnormal stresses are placed on the graft that could lead to graft failure. An alternative technique for posterior cruciate ligament reconstruction involves placement of the bone plug from the graft anatomically on the back of the tibia (inlay), preventing formation of an acute angle at the tibial attachment site. We used six pairs of human cadaver knees to compare the biomechanical properties of these two techniques. One knee from each pair underwent tunnel reconstruction while the other knee underwent inlay reconstruction. There was significantly less anterior-posterior laxity in the inlay group when compared with the tunnel group from 30° to 90° of knee flexion and after repetitive loading at 90° of knee flexion. Evaluation of the grafts revealed evidence of mechanical degradation in the tunnel group but not in the inlay group. The inlay technique resulted in less posterior translation with less graft degradation than did the tunnel technique for posterior cruciate ligament reconstruction.
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