David R. McAllister, MD and John A. Bergfeld, MD
The most common method of posterior cruciate ligament reconstruction utilizes a transtibial tunnel in which the graft must pass around an acute angle at the posterior aspect of the tibia. This acute angle is referred to as the "killer curve". It has been shown that when the graft is tensioned at its tibial end, applied graft pretension decreases because of frictional loss at this corner. It is also believed that a graft in this orientation would be subjected to high local tissue strains as a consequence, probably attributing to the high rate of abnormal posterior laxity after PCL reconstructions. In addition, it is unclear whether the tibial tunnel can be accurately and consistently placed within the tibial insertion footprint of the native PCL with this technique. For these reasons, surgeons have sought other reconstruction techniques in an attempt to improve clinical outcomes.
The tibial inlay technique for posterior cruciate ligament reconstruction, first introduced in Europe, is superior to the tunnel technique with respect to graft failure, graft thinning, and permanent increase in graft length.
John A. Bergfeld, M.D. of the Cleveland Clinic joins David R. McAllister, M.D. of UCLA in this JBJS/VJO Video Supplement to discuss and present the surgical technical for this procedure .
- Indications / Contraindications
- Physical Exam & Conservative Treatment
- Femoral Preparation
- Posterior Incision
- Bone Trough
- Closure & Postoperative Protocol
- Important "Pearls" in Avoiding Complications
See the Corresponding JBJS Article:
- Keith L. Markolf, Jason R. Zemanovic, and David R. McAllister.
- Cyclic Loading of Posterior Cruciate Ligament Replacements Fixed with Tibial Tunnel and Tibial Inlay Methods.
J Bone Joint Surg Am 2002 84: 518-524. [Article]
- Total Run Time: 24:27 minutes
- Catalog Number: 5070
- VJO Publication Date: June, 2002