All-Inside PCL Reconstruction

Therrien, Erik; Pareek, Ayoosh; Song, Bryant M.; Wilbur, Ryan R.; Stuart, Michael J.; Levy, Bruce A.

doi:10.1055/s-0040-1722313

Cited by 10 publications

(12 citation statements)

References 14 publications

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“…After receiving institutional review board approval, we identified consecutive patients who underwent a primary PCLR using the all-inside technique 9 , 27 , 30 , 40 from October 2012 to January 2019. Over the study period, all surgeries were performed by fellowship-trained orthopaedic surgeons (M.J.S.…”

Section: Methodsmentioning

confidence: 99%

“…The preferred technique of the surgeons was all-inside PCLR using a quadrupled peroneus longus or tibialis anterior tendon allograft with both tibial and femoral suspensory fixation. 40 A quadruple looped allograft with a final length of approximately 90 mm with a final diameter between 10 and 12 mm was used for all reconstructions. A 40-mm tibial socket was drilled using the anatomic PCL Tibial Guide (Arthrex) and the FlipCutter II (Arthrex).…”

Section: Methodsmentioning

confidence: 99%

“…The rehabilitation was standardized between the groups and has been described in detail. 9 , 24 , 40 Briefly, touch weightbearing during ambulation with crutches and a custom PCL brace locked in extension were allowed for the first 6 weeks. Gradual weightbearing was introduced with a goal of full range of motion and normal gait at 12 weeks; bracing was continued for up to 12 months postoperatively.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement

Therrien

Pareek

Song

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Biomechanical studies support the use of suture tape reinforcement for limiting graft elongation and increasing strength in knee ligament reconstructions. Purpose: To compare posterior cruciate ligament (PCL) laxity, complication and reoperation rates, and patient-reported outcomes (PROs) after all-inside single-bundle PCL reconstruction (PCLR) with versus without independent suture tape reinforcement. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study of consecutive patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement at a single academic institution from 2012 to 2019. Medical records were reviewed for patient characteristics, additional injuries, and concomitant procedures. PRO scores (including the International Knee Documentation Committee [IKDC], Tegner activity scale, and Lysholm scores), bilateral comparison kneeling radiographs, and physical examination findings were collected at a minimum of 2 years postoperatively. Results: Included were 50 patients: 19 with suture tape reinforcement (mean age 30.6 ± 2.9 years) and 31 without suture tape reinforcement (control group; mean age 26.2 ± 1.6 years). One PCLR graft in the suture tape group failed. Posterior drawer examination revealed grade 1+ laxity in 4 of 19 (21%) of the suture tape cohort versus 6 of 31 (19%) of the control cohort ( P > .999). Bilateral kneeling radiographs showed similar side-to-side differences in laxity between the groups (suture tape vs control: mean, 1.9 ± 0.4 vs 2.6 ± 0.6 mm; P = .361). There were no statistically significant differences between the groups in postoperative IKDC (suture tape vs control: 79.3 vs 79.6; P = .779), Lysholm (87.5 vs 84.3; P = .828), or Tegner activity (5.6 vs 5.7; P = .562) scores. Conclusion: All-inside single-bundle PCLR with and without independent suture tape reinforcement demonstrated low rates of graft failure, complications, and reoperations, with satisfactory PROs at a minimum 2-year follow-up. Radiographic posterior tibial translation was comparable between the 2 groups.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement

Therrien

Pareek

Song

et al. 2022

Orthopaedic Journal of Sports Medicine

Self Cite

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“…This area, the "no-safe zone", makes some knee surgeons less confident and willing to perform this surgical procedure [3][4][5]. Surgical reconstruction of the PCL can be performed using two main techniques: the tibial tunnel or the tibial inlay technique [6,7]. The tibial tunnel technique approaches the PCL tibial insertion using a specific guide under arthroscopic control and, in some circumstances, fluoroscopic control.…”

Section: Introductionmentioning

confidence: 99%

Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

et al. 2023

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Background Surgical reconstruction of the posterior cruciate ligament (PCL) can be technically challenging given the proximity of the popliteal artery to the PCL tibial insertion. This "no-safe zone" makes some knee surgeons less confident and willing to perform this surgical procedure. Surgical technique We present a PCL tibial inlay reconstruction technique using a set of instruments involving three tools (a slot cut, a bone plug positioner, and an impactor). Conclusion This set of instruments allows a more reproducible posteromedial approach and to produce a PCL tibial slot in a posterior cruciate ligament inlay reconstruction with the patient supine in bicruciate ligament injury reconstruction.

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“…[21][22][23][24][25] Persistent posterior laxity has been the most commonly reported complication of PCLR with single-bundle and isometric techniques associated with the highest incidences. [26][27][28][29] Based on reported advantages and disadvantages, we have employed two tibial fixation techniques, transtibial (TT) 4,30 with an all-soft tissue graft [30][31][32] and tibial inlay (TI) with a bone block 33,34 , for anatomic double-bundle PCLRs. Selection of TT versus TI has been primarily governed by the presence of additional injuries to the knee, previous attempts at PCLR, and the patient's body mass index (BMI).…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Anatomic Double-Bundle Posterior Cruciate Ligament Reconstructions Using Transtibial and Tibial Inlay Techniques

et al. 2022

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Introduction: Surgical reconstruction is recommended for symptomatic posterior cruciate ligament (PCL). While anatomic double-bundle PCL reconstruction (PCLR) has been reported to be associated with biomechanical and clinical advantages over other methods, there is still debate regarding the optimal technique for tibial positioning and fixation. Based on reported advantages and disadvantages, we employed two tibial fixation techniques, transtibial (TT) and tibial inlay (TI) for anatomic double-bundle PCLR with technique selection based on BMI, comorbidities, and primary versus revision surgery. This study aimed to compare clinical outcomes following PCLR utilizing either TT or TI techniques in order to validate relative advantages, disadvantages, and indications for each based on review of prospectively collected registry data. Materials & Methods: For 37 patients meeting inclusion criteria, 26 underwent arthroscopic TT PCLR using an all-soft tissue allograft with suspensory fixation in the tibia and 11 patients underwent open TI PCLR using an allograft with calcaneal bone block and screw fixation in the tibia. There were no significant pre-operative differences between cohorts. Results: Success rates were 96% for TT and 91% for TI with all successful cases documented to be associated with good to excellent posterior stability and ROM in the knee at final follow-up. In addition, patient-reported outcomes scores were within clinically meaningful ranges for pain, function, and mental health after PCLR in both cohorts, suggesting similarly favorable functional, social, and psychological outcomes. Patient reported pain scores at six months post-operatively were significantly (p=0.042) lower in the TT cohort, which was the only statistically significant difference in outcomes noted. Conclusion: The results of this study supports the use of transtibial and tibial inlay techniques for double-bundle anatomic PCLR in restoring knee stability and patient function when used for treatment of isolated and multi-ligamentous PCL injuries. Choice between tibial fixation methods for PCLR can be appropriately based on patient and injury characteristics that optimize respective advantages for each technique.

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All-Inside PCL Reconstruction

Cited by 10 publications

References 14 publications

Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement

Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement

Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

Outcomes after Anatomic Double-Bundle Posterior Cruciate Ligament Reconstructions Using Transtibial and Tibial Inlay Techniques

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