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First published on March 11, 2004, doi:10.1177/0363546503261717
This version was published on April 1, 2004
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The American Journal of Sports Medicine 32:587-593 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Biomechanical Comparison of Tibial Inlay Versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction

Analysis of Knee Kinematics and Graft In Situ Forces

Fabrizio Margheritini, MD, Craig S. Mauro, Jeffrey A. Rihn, MD, Kathryne J. Stabile, MS, Savio L-Y. Woo, PhD and Christopher D. Harner, MD*

From the Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

* Address correspondence to Christopher D. Harner, 3200 S. Water Street, Pittsburgh, PA 15203 (e-mail: harnercd{at}upmc.edu).

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.

Hypothesis: 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: 0º, 30º, 60º, 90º, and 120º. 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.

Clinical Relevance: The study suggests that either technique may be performed with similar biomechanical results at initial fixation under these loading conditions.

Key Words: posterior cruciate ligament (PCL) • tibial inlay • biomechanics




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