A method of pre-operative assessment for posterior cruciate ligament reconstruction

The use of the bone-patellar tendon-bone graft has been well established in anterior cruciate ligament (ACL) reconstruction. The value of this graft in posterior cruciate ligament (PCL) reconstruction has not been documented. A template was used to identify the origin and insertion of the PCL on standard lateral radiographs of the knee. Those patients who were found at arthroscopy to have an intact articular surface were measured using the template. Thirty-nine patients (40 knees) were included for study, the difference between the PCL and patellar tendon length was expressed as a percentage. The mean was 125% (range 98-165%). To assess the reproducibility of the technique, in 17 patients a repeat radiograph was taken and the two measurements compared. These were found to have a significant correlation (Rs coefficient 0.79, P < 0.001). The use of autologous bone-patellar tendon-bone graft obviates the need for allograft with its incumbent problems. This method of measurement indicates that the patellar tendon graft would be long enough to be suitable for PCL reconstruction in the majority of cases.