Posterior cruciate ligament reconstruction: Transtibial technique

Isolated tears of the posterior cruciate ligament (PCL) have traditionally been treated nonoperatively. Long-term follow-up studies, however, have shown a higher incidence of osteoarthritis and poor patient function in this patient group. There are several reasons for the inability of current surgical techniques to restore normal laxity to a PCL-deficient knee, including the use of grafts of insufficient strength, improper tunnel placement, and the failure to recognize and treat associated laxities. Techniques have been emerging to reconstruct both the anterolateral and posteromedial bands of the PCL and to tension them so that one band of the double graft will resist posterior tibial translation through a full range of knee motion. Biomechanical studies suggest that this can be accomplished. A transtibial tunnel technique is most commonly employed for PCL reconstruction. A properly placed single tibial tunnel will suffice for either a single or a double femoral tunnel technique. Early operative intervention with two-graft PCL reconstructions appears to provide better resistance to posterior tibial translations through a full range of motion. Whether these grafts will continue to function over time and delay the arthritic changes associated with PCL insufficiency better than a single graft technique is yet to be determined.