Biomechanical Comparison of Tibial Inlay versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction

Margheritini, Fabrizio; Mauro, Craig S.; Rihn, Jeffrey A.; Stabile, Kathryne J.; Woo, Savio L‐Y.; Harner, Christopher D.

doi:10.1177/0363546503261717

Cited by 77 publications

(52 citation statements)

References 28 publications

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“…Applying 1,000 cycles of posterior load of 100-N in this study resulted in no graft rupture at the killer turn in the BTB-tunnel and no significant difference in PTT as well as laxity increase between the BTB-tunnel and the BTB-inlay. These findings are in accordance with previous studies [12,14]. According to the literature on the cyclic loading tests to the PCL reconstructed-knee, a load of 300-N represents a load level during an aggressive rehabilitation program, and a load of 89-N simulates mechanical conditions during continuous passive knee motion [15].…”

Section: Discussionsupporting

confidence: 92%

Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests

Hiraga

Ishibashi

Tsuda

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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Posterior tibial translation (PTT) of the posterior cruciate ligament (PCL) reconstructed-knee under cyclic loading of 1,000 cycles with a 100-N load was compared between four different procedures, including two reconstructions with patellar tendon graft (transtunnel and inlay techniques) and two reconstructions with hamstring tendon graft (Endobutton and EndoPearl techniques) in twelve fresh-frozen human knees. The EndoPearl technique is a direct tendon fixation using biodegradable interference screws and an anchoring device, while the Endobutton technique is an indirect tendon fixation using a titanium button and surgical tape. The change of PTT after cyclic loading in the Endobutton technique was significantly greater than in the other reconstruction technique. No graft rupture at the killer turn or complete pullout from the bone tunnel was found. The advantage of the inlay technique compared to the transtunnel technique with respect to the posterior stability could not be shown in the current study. Posterior laxity of PCL reconstructed-knees with hamstring tendon graft using the Endobutton technique increased more easily than that with patellar tendon graft. For PCL reconstruction using the hamstring tendon graft, anatomical fixation may be preferable to prevent excessive posterior laxity in the early phase of the rehabilitation protocol.

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Section: Discussionsupporting

confidence: 92%

Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests

Hiraga

Ishibashi

Tsuda

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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“…Other studies have reported the transverse lengths at the femoral insertion, central portion and tibial insertion levels (Triantafyllidi et al;Fanelli et al;Sheps et al, 2005;Margheritini et al, 2004;Cosgarea & Jay, 2001;Stähelin et al, 2001). Harner et al (1999) discovered that the AL fascicle is greater than the PM, which differs from data reported by Takahashi The most relevant finding of this study was that the PCL did not have the same dimension for the entirety of its length, replicating the "sand clock" form with wide bases and a thin center, particularly in its anteroposterior length.…”

Section: Discussioncontrasting

confidence: 81%

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Compeán-Martínez¹,

Morales-Ávalos²,

Vílchez-Cavazos³

et al. 2015

Int. J. Morphol.

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COMPEÁN-MARTÍNEZ, G. A.; MORALES-AVALOS, R.; VÍLCHEZ-CAVAZOS SUMMARY:To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomical position during posterior cruciate ligament (PCL) reconstruction. Ten knees were dissected to analyze femoral and tibial PCL insertion measurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral insertions. The meniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its corresponding fascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between the central point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm (±3.94) and 17.73 mm (±4.11) for the right and left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm (±5.08) between the posterior PCL border and the anterior PCL border. The mean lengths were 33.52 mm (±3.49) from the medial border of the lateral meniscus to the lateral PCL border and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposterior viewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its central portion. A quantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various femoral and tibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengths reported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligament plasty. We must take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graft with the surrounding structures.

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“…Despite the technique used, current PCL reconstruction methods do not consistently restore posterior tibial translation to that of the contralateral knee [4,17,34]. Residual increased posterior translation of the tibia has been documented after traditional transtibial techniques [11,17,22,28], and postoperative stability of the knee and subjective patient outcomes are not improved after alternative approaches such as tibial inlay fixation techniques [14,18,19,21,24,31] or double-bundle reconstruction of the PCL [1,2,8,10,35].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

Gill

Velde

Carroll

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Biomechanical Comparison of Tibial Inlay versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction

Abstract: The study suggests that either technique may be performed with similar biomechanical results at initial fixation under these loading conditions.

Cited by 77 publications

References 28 publications

Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests

Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

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