Biomechanical comparison of tibial inlay versus transtibial techniques for posterior cruciate ligament reconstruction: analysis of knee kinematics and graft in situ forces.
BACKGROUND
The tibial inlay technique for posterior cruciate ligament reconstruction has been proposed to provide a more anatomic reconstruction because it eliminates the sharp turn in the graft as it exits the proximal margin of the tibial tunnel in the transtibial technique.


OBJECTIVE
Reconstruction of the posterior cruciate ligament using the tibial inlay technique would more closely restore intact knee kinematics and in situ forces in the posterior cruciate ligament than would reconstruction using the transtibial technique.


METHODS
Ten human cadaveric knees were tested in a controlled laboratory study. A robotic/universal force-moment sensor testing system was used to apply a 134-N posterior tibial load at 5 knee flexion angles: 0 masculine, 30 masculine, 60 masculine, 90 masculine, and 120 masculine. Four knee conditions were tested: intact, posterior cruciate ligament-deficient, and the single-bundle tibial inlay reconstruction and transtibial posterior cruciate ligament reconstruction.


RESULTS
Both reconstruction techniques restored posterior tibial translations to 1.7 to 2.1 mm of the intact knee, with no statistical differences between the techniques. In response to the posterior tibial load, in situ forces in both grafts were between 7 and 39 N less than those in the intact posterior cruciate ligament, with no significant differences between the grafts.


CONCLUSIONS
The study suggests that either technique may be performed with similar biomechanical results at initial fixation under these loading conditions.
Margheritini
Fabrizio
F
Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Mauro
Craig S
CS
Rihn
Jeffrey A
JA
Stabile
Kathryne J
KJ
Woo
Savio L-Y
SL
Harner
Christopher D
CD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods; D002102:Cadaver; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013314:Stress, Mechanical; D013977:Tibia / Q000601:surgery*; D014182:Transplantation, Autologous