Arthroscopic reconstruction of the posterior cruciate ligament using tibial-inlay and double-bundle technique

Biomechanical research has suggested that the double-bundle and tibial inlay technique is superior to the single-bundle and the transtibial tunnel method for posterior cruciate ligament (PCL) reconstruction. A combination the posterior tibial inlay and femoral double-bundle technique is thought to be an ideal method for PCL reconstruction. Recently, we successfully performed arthroscopic PCL reconstruction using the tibial-inlay and double-bundle technique. Achilles tendon-bone allograft is used and the bone plug for the arthroscopic tibial inlay fixation is designed in a cylindrical shape and perpendicular to the fiber texture of the Achilles tendon. Achilles tendon is manually split into deep and superficial layers to reconstruct anterolateral and posteromedial bundles as the natural insertion of PCL. The intra-articular lengths of each bundle between tibial tunnel and 2 femoral tunnels are measured to achieve fixation of the graft to the original PCL attachment. After tibial bone plug fixation with an absorbable interference screw and additional suture anchoring, the anterolateral bundle is fixed in a reduction position with the knee in 90 degrees of flexion and the posteromedial bundle is fixed nearly in extension. This procedure makes it possible not only to reproduce the original concept of PCL tibial inlay graft arthroscopically without posterior arthrotomy, but also to achieve a more anatomic PCL reconstruction of the 2 bundles.