All-Inside Posterior Cruciate Ligament Reconstruction Using Achilles Allograft and Suture Tape Augmentation

Posterior cruciate ligament (PCL) reconstruction is challenged by graft elongation and delayed biological integration, often necessitating slow rehabilitation and carrying a risk of arthrofibrosis. This technical report describes an all-inside technique augmented with the modified internal bracing to address these limitations. The technique involves integrating a FiberTape within a quadrupled Achilles tendon allograft, creating a load-sharing composite. An all-inside, retrograde socket method was used for anatomic PCL reconstruction in the knee, with suspensory fixation on both femur and tibia. The graft-tape construct was simultaneously tensioned. The technique provides immediate biomechanical stability by mitigating graft micromotion, elongation, and tunnel abrasion. By closely replicating native PCL stiffness, this construct facilitates an accelerated, protective rehabilitation protocol focused on early motion and quadriceps activation, thereby aiming to reduce failure rates and postoperative stiffness. This method represents a synergistic evolution in PCL reconstruction, combining synthetic reinforcement with biological healing.