Tibial inlay technique using hamstring graft for posterior cruciate ligament reconstruction and remnant revision

The posterior tibial inlay technique is currently accepted as a standard operation for the posterior cruciate ligament-deficient knee. The classical technique requires a graft construct consisting of a bony part to be fitted into the posterior tibial socket. When an autogenous source is chosen, morbidity at the donor site generated by obtaining the graft with a bony part (e.g., bone-patellar tendon-bone or quadriceps tendon-bone) can be more serious than when obtaining the soft-tissue graft (e.g., hamstring). This study describes an alternative use of soft-tissue graft anchored in a bone socket at the posterior tibial margin by a transfixing cancellous screw. The graft is secured on top by a "bone washer" harvested from this bone socket to provide biological bone-tendon-bone healing. The posterior cruciate ligament remnant with integral fibers at the femur can have its tibial part revised, tensioned, and reattached concomitantly. This additional procedure is deemed to enhance joint stability and promote graft healing.