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Document Title: Noyes-AJARS-Oct03.shtml
Article Title: Arthroscopically assisted quadriceps double-bundle tibial inlay posterior cruciate ligament reconstruction: an analysis of techniques and a safe operative approach to the popliteal fossa
Authors: Frank R. Noyes MD, Michael J. Medvecky MD, Manoj Bhargava MD
Publication: Arthroscopy: The Journal of Arthroscopic and Related Surgery
Date: October 2003
Volume 19, Issue 8, pages 894-905
Keywords: PCL reconstruction, tibial inlay, anatomy, double-bundle, knee dislocation (tibiofemoral dislocation, not to be confused with patellar dislocation).
(Reference-denoting numbers appear in the same point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This superb and highly insightful article delves deeply into the topic of anatomical optimization of PCL reconstruction. Dr. Noyes is a pioneer in the use of two separate bundles for PCL reconstruction. This method, albeit more demanding for the surgeon to perform, makes the grafted PCL and the resulting knee motion much more similar to that of a normal knee. This article is a must-read for anyone whose knee harbours PCL tearing and for whom reconstructive surgery has been proposed.
ABSTRACT
The arthroscopically assisted posterior cruciate ligament tibial inlay technique, frequently used in athletic individuals and in revision cases, requires a thorough and comprehensive understanding of posterior knee anatomy. Importantly, variations in the posterior vascular anatomy may be encountered. A safe and methodical posteromedial approach in a layered fashion to achieve proper and safe tibial inlay graft placement and fixation is described. The authors advocate use of a double-bundle quadriceps tendon autograft. Graft position of the double strands, fixation, and tensioning issues are presented.
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