Description of a new endoscopic posterior cruciate ligament reconstruction and comparison with a 2-incision technique

We introduce our technique (a new route for the graft) of endoscopic posterior cruciate ligament (PCL) reconstruction and describe the advantages in comparison with the conventional surgical technique.

Nonrandomized control study.

The idea of this surgical technique is to minimize graft angulation at the inner edge of the bone tunnel. The tibial entry point of the guide pin is under the tibial lateral subcondylar flare, approximately 1 to 2 cm anterior to the posterior cortex. This creates less graft angulation on the posterior aspect of the tibia. A new drill system has been devised to allow antegrade femoral drilling starting from inside the notch. This method also allows better femoral tunnel orientation. As a substitute graft material, we use autogenous hamstring tendons, and we secure them with an EndoButton (Smith & Nephew, Andover, MA) and post screw. From 1992 to 1995, 43 2-incision PCL reconstructions using autogenous hamstring tendons were performed. From 1995 to 2001, 90 endoscopic PCL reconstructions using looped autogenous hamstring tendons and an EndoButton were performed. Cases were specified according to the inclusion criteria of this study. As a result, 51 patients were included in this study. The 2-incision group comprised 22 patients, and the endoscopic group comprised 29 patients. The clinical evaluation was performed using the International Knee Documentation Committee (IKDC) form. The quadriceps strength was measured using Biodex System II (Biodex, New York, NY). The period of time to achieve 90 degrees flexion after surgery was also compared.

No significant differences were seen between the 2 groups tested with respect to the overall IKDC rating score. Side-to-side differences of anteroposterior total laxity (KT-1000, manual maximum) was 3.95 +/- 1.96 mm in the 2-incision group and 2.38 +/- 1.42 mm in the endoscopic group (P <.05). The average time to achieving 90 degrees of flexion after surgery was 16.6 +/- 8.6 days in the 2-incision group and 12.1 +/- 3.5 days in the endoscopic group. Achievement of range of motion in the endoscopic group was significantly shorter. The peak torque of isokinetic contraction in the endoscopic group was significantly greater than in the 2-incision group 1 year after surgery.

Better posterior stability and quicker postoperative recovery of range of motion and muscle strength were advantages of the endoscopic technique over the 2-incision technique in PCL reconstruction.