Anatomic PCL Reconstruction: The Double Bundle Inlay Technique

This paper describes an anatomic method of reconstructing the posterior cruciate ligament (PCL) that combines the inlay and double bundle techniques using an Achilles tendon allograft. This technique is based on the rapidly improving understanding of the complex anatomy of the PCL. Current controversies are also discussed. Forty-nine knee dislocation patients with 50 anatomic PCL reconstructions have been followed with extensive outcome data. Mean length of follow-up is 56 months, with a minimum follow-up of 20 months. There were 4 failures (7%) out of 54 primary or revision PCL reconstructions. Patients achieved an average of a 122° arc of motion with excellent posterior stability, based on both physical examination and KT-2000 ligament arthrometer examinations. Good to excellent outcomes were achieved by most patients when evaluated using the Lysholm knee score and International Knee Documentation Committee (IKDC) score. Most patients were able to return to full-time work but only half were able to resume their prior level of recreation activities. The anatomic PCL reconstruction functions well in the medium to long-term follow-up. We recommend allograft reconstruction that uses an Achilles tendon allograft as a good strategy to treat knee dislocation patients who have sustained a PCL tear.