Tibial Inlay Posterior Cruciate Ligament Reconstruction: Advances to a New Technique

Graft instability can be a long-term concern for orthopaedic surgeons who arthroscopically reconstruct the posterior cruciate ligament (PCL). Dissatisfaction over reconstruction methods led the senior author to develop a new method that combined both a tibial inlay and the double-bundle techniques. Long-term results over 15 years were satisfactory but there were still several disadvantages—pain, the risk of wound healing issues in patients with severely injured knee dislocation, and the potential for vascular injury. Recent advances in technology have the potential to address these disadvantages and further improve clinical outcomes. The authors developed a new arthroscopic all-inside transtibial PCL double-bundle allograft reconstruction technique using cortical-button suspensory fixation of a soft tissue graft in sockets. This technique yields a tibial location identical to that of the tibial inlay and functions in a very similar manner. This article shows the PCL graft preparation and technique used in this surgery. Early results have provided clinical support for its safety and efficacy but more long-term follow-up is necessary to validate the relative efficacy of this technique.