Tensioning of Remnant Posterior Cruciate Ligament and Reconstruction of Anterolateral Bundle in Chronic Posterior Cruciate Ligament Injury

Purpose Posterior cruciate ligament (PCL) injuries have potential for intrinsic healing and several magnetic resonance imaging studies have reported that the PCL healed with continuity but also with residual laxity. The goal of our study was to introduce a new method and investigate the outcome of tensioning of the remnant PCL and reconstruction of the anterolateral (AL) bundle of the PCL using modified inlay technique. Type of Study Therapeutic study. Methods Forty‐nine patients who underwent tensioning of the remnant PCL and reconstruction of the AL bundle of the PCL were evaluated 45.7 months (range, 24 to 78 months) on average after surgery. Tensioning was performed by distal transfer of the tibial attachment. The AL bundle of the PCL was reconstructed with 4 bundles of hamstring tendon (34 cases), bone–patellar tendon–bone graft (7 cases), or Achilles tendon allograft (8 cases), arthroscopically at the femoral tunnel and by the modified inlay technique through a posteromedial approach in the supine position. In 35 patients who had a combined posterolateral rotatory instability, the posterolateral corner reconstruction was performed. Stability was assessed by stress radiographs with the Telos device and maximal manual testing with KT‐1000 arthrometer. The clinical results were assessed by IKDC and OAK scores. Physical examination was performed using the posterior drawer test, varus stress test, posterolateral drawer test, and dial test in 30° and 90° flexion. Results The average side‐to‐side difference of posterior tibial translation on posterior stress radiographs decreased from 10.4 ± 2.1 mm to 2.2 ± 1.0 mm. The average side‐to‐side difference in maximal manual test with the KT‐1000 arthrometer also decreased from 8.2 ± 1.5 mm to 1.9 ± 1.0 mm. The final IKDC score was A in 10 (20.4%), B in 33 (67.3%), and C in 6 (12.2%) patients. The average OAK score improved from 63.3 ± 8.3 to 91 ± 7.3. Conclusions Good clinical results and very good posterior stability were achieved with tensioning of the remnant PCL and reconstruction of the AL bundle using the modified inlay technique in chronic PCL injuries. With this technique, the surgeon can operate without changing the patient's position during surgery. Level of Evidence Level IV, therapeutic study.