Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study

The most common technique for posterior cruciate ligament (PCL) reconstruction is transtibial or tibial inlay. However, few studies have reported long-term outcome comparisons between the 2 techniques.

Tibial inlay PCL reconstruction with patellar tendon autograft will exhibit better clinical and radiographic outcomes than transtibial PCL reconstruction with hamstring autograft.

Cohort study; Level of evidence, 3.

A total of 66 patients (66 knees) treated with PCL reconstruction for chronic injuries constituted the study cohort. Patients were divided into 2 groups: transtibial with hamstring (36 patients) and tibial inlay with patellar tendon (30 patients). The mean time from injury to reconstruction was 12.2 months (range, 2-60 months), and the mean follow-up was 148 months (range, 98-196 months). Outcomes were measured by use of Lysholm knee scores, Tegner activity scores, return to preinjury sports activity, posterior drawer test, laxity test with a Telos device, and development of osteoarthritis.

The preoperative mean Lysholm knee score was 59.9 (range, 37-70) in the transtibial group and 54.5 (range, 22-76) in the tibial inlay group, improving postoperatively to 89.9 (range, 74-100) and 92.1 (range, 80-100), respectively. The mean Tegner activity scores increased from 2.5 (range, 2-5) to 5.9 (range, 4-7) in the transtibial group and 2.3 (range, 2-4) to 6.0 (range, 3-8) in the tibial inlay group. Twenty-one patients (58.3%) in the transtibial group and 19 patients (63.3%) in the tibial inlay group were able to return to preinjury sports activity. In the posterior drawer test, 6 patients in the transtibial group and 4 patients in the tibial inlay group showed grade II laxity. The mean side-to-side difference was 10.1 mm (range, 7-12 mm) in the transtibial group and 10.4 mm (range, 9-13 mm) in the tibial inlay group, improving postoperatively to 4.1 mm (range, 0-8 mm) and 4.2 mm (range, 1-8 mm), respectively. There was significant improvement between preoperative and final follow-up values. However, there were no significant differences between the 2 groups in final follow-up outcomes. Final follow-up radiographs showed that 6 patients (16.7%) in the transtibial group and 3 patients (10.0%) in the tibial inlay group were rated grade C according to International Knee Documentation Committee guidelines.

Clinical and radiographic outcomes between the 2 PCL reconstruction techniques were comparable. Osteoarthritis was observed in patients, with a significant proportion presenting loss of joint space. Examined factors, excluding meniscectomy, were not correlated with the development of osteoarthritis.