title: Open tibial inlay versus arthroscopic transtibial posterior cruciate ligament reconstructions.
abstract: OBJECTIVE
  The optimal method of posterior cruciate ligament (PCL) reconstruction is not known. The purpose was to evaluate the biomechanical and clinical literature comparing open tibial inlay and arthroscopic transtibial PCL reconstructions and determine which method of reconstruction is superior.
  
  
  METHODS
  A systematic review of the literature was performed on PubMed. Biomechanical and clinical studies comparing the outcomes of open tibial inlay and arthroscopic transtibial PCL reconstructions were selected and reviewed.
  
  
  RESULTS
  Biomechanical studies evaluating posterior stability found no difference or increased stability with open inlay reconstruction. Graft degradation at the killer turn after arthroscopic transtibial reconstruction was described in some of the biomechanical studies. Biomechanical studies found no significant difference in graft forces after cyclic loading between the 2 groups. Biomechanical studies were influenced by methodologic limitations of graft fixation, power analysis, graft tensioning protocol, and magnitude of load applied for cyclic loading. Clinical studies with some methodologic limitations found no significant difference in maintaining posterior stability between the 2 reconstruction groups at short-term follow-up.
  
  
  CONCLUSIONS
  The advantage of open inlay or arthroscopic transtibial PCL reconstruction techniques remains uncertain in the setting of conflicting biomechanical studies, with notable limitations in clinical studies. The arthroscopic tibial inlay technique may provide benefits of both open inlay and transtibial reconstruction techniques and comparable stability to the conventional PCL reconstruction methods according to several biomechanical studies.
  
  
  METHODS
  Level IV, systematic review.
authors.affiliation: MedSport-Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Hemang B
authors.initials: HB
authors.lastname: Panchal
authors.forename: Jon K
authors.initials: JK
authors.lastname: Sekiya
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D050376:Bone-Patellar Tendon-Bone Grafting / Q000379:methods*; D005269:Femur / Q000601:surgery; D005544:Forecasting; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007718:Knee Injuries / Q000534:rehabilitation; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing