Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

Area of Science:

• Orthopedic Surgery
• Knee Biomechanics
• Ligament Reconstruction

Background:

• The posterior cruciate ligament (PCL) stabilizes the knee, comprising anterolateral (ALB) and posteromedial (PMB) bundles.
• Historically, bundles were thought to function independently, but recent studies suggest codominance.
• Single-bundle PCL reconstruction, often focusing on the ALB, may lead to residual instability and altered knee kinematics.

Purpose of the Study:

• To evaluate the efficacy of anatomic double-bundle PCL reconstruction in restoring knee kinematics and improving patient outcomes.
• To compare the outcomes of double-bundle PCL reconstruction with traditional single-bundle techniques.

Main Methods:

• Anatomic double-bundle PCL reconstruction utilizing native footprints to recreate both ALB and PMB.
• Graft preparation using Achilles tendon (ALB) and tibialis anterior (PMB) allografts.
• Specific techniques for femoral and tibial tunnel creation, graft fixation, and independent tibial fixation at varying knee flexion angles.

Main Results:

• Double-bundle PCL reconstruction demonstrated improved subjective and objective patient outcomes with a low complication rate.
• Prospective studies indicate similar clinical outcomes between isolated transtibial techniques.
• Objective measures of posterior translation and International Knee Documentation Committee scores were significantly improved with double-bundle compared to single-bundle reconstructions.

Conclusions:

• Anatomic double-bundle PCL reconstruction effectively restores normal knee kinematics and provides superior objective stability compared to single-bundle methods.
• This technique offers improved patient outcomes for acute and chronic PCL tears, including those with multiligament or meniscal involvement.
• Indications range from acute grade-III PCL tears to chronic tears with functional limitations and significant laxity.