[Arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using calcaneal-tendon allograft]

To evaluate the surgical approach and the clinical outcome of arthroscopic transtibial double-bundle and double-tunnel posterior cruciate ligament(PCL) reconstruction using calcaneal-tendon allograft.

Ten patients with knee instability caused by PCL rupture were treated by arthroscopic PCL reconstructions using calcaneal-tendon allograft only by anterior approach between March, 2002 and April, 2003. First, the square bone block 10 mm in diamter, which is connected with a band of calcaneal tendon 12 mm in diameter, was fixed into the tibial tunnel. Then, the tendon was divided into two parts with a proportion of 3 : 2 (7 mm : 5 mm), which were fixed into the anterolateral (AL) and posteromedial (PM) tunnels in medial femoral condyle respectively. The knees were fixed with plaster slabs or braces for 4 weeks after operation. The periods of follow-up were 12 to 48 months (average, 32 months),and the outcome was evaluated by Lachman's test, posterior drawer test (PDT), and Lysholm scorses.

Knee instability was seen no more in the 10 cases after operation. Recovery of stability in coronary axis was apparent. The results of Lachman's test and PDT were both positive in every case before operation, but became negative after operation. Extension and flexion of knee joints became normal. Lysholm scores rose from 58 (pre) to 93 (post). Joint function of nine cases reached excellent level, one case reached good level, and the total rate of excellence and good was 100%. Clinical observations suggested that immunological rejection was mild (only one patient had a low fever); meanwhile, no surgical complication happened. During 48 months, no ligament looseness was observed. Satisfactory clinical outcome was achieved in the whole group.

Double-bundle and double-tunnel PCL reconstruction using calcaneal-tendon allograft is a good surgical approach, which not only avoids injuring the donor area, but also accords with the anatomical structure of PCL. The short-term outcome has been proved, but long-term outcome needs more observations.