Replacement of the torn posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method.
BACKGROUND
The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure.


METHODS
Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up.


RESULTS
The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 +/- 1.9 mm preoperatively to 3.4 +/- 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 +/- 2.1 mm preoperatively to 1.8 +/- 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 +/- 6.8 to 92.5 +/- 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft.


CONCLUSIONS
Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery.
Jung
Young-Bok
YB
Department of Orthopaedic Surgery, Yong-San Hospital of Chung-Ang University, 3-65, Hangang-Ro, Yongsan-Gu, 140-757, Seoul, Korea. jungyb2000@hanmir.com
Tae
Suk-Kee
SK
Jung
Ho-Joong
HJ
Lee
Kee-Hyun
KH
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010329:Patella; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery*; D016683:Supine Position; D013710:Tendons / Q000637:transplantation*