Arthroscopic posterior cruciate ligament Tibial inlay reconstruction: A surgical technique that May influence Rehabilitation

Isolated posterior cruciate ligament (PCL) injuries continue to produce a conundrum for treating surgeons. Biomechanical studies have suggested that the medial and patellofemoral compartments in the PCL-deficient knee experience increased abnormal forces that may lead to premature and severe arthritis.3 Historically, good outcomes were reported with nonoperative management, but more recent biomechanical and longer-term clinical studies have suggested that this is not the case.3,7,9,15 These less-than-optimal outcomes could be attributed to more complex injury patterns that may have been overlooked or misdiagnosed. Recent studies have also shown that high-grade (III) laxity in the PCL-deficient knee may not be an isolated injury.12,21,22 This examination finding is a harbinger of a combined posterolateral corner (or posteromedial corner) and PCL injury.21 Some authors have advocated PCL reconstruction in patients that have this high degree of laxity (8 to 10 mm greater than the contralateral side) in an attempt to minimize the poor outcomes and premature arthrosis associated with the chronically PCL-deficient knee.11,14 Another clear indication for PCL reconstruction is the patient with a truly isolated PCL injury that remains symptomatic despite adequate rehabilitation.6 The most common indication for PCL reconstruction is the multiligamentous knee injury. A slow and more deliberate rehabilitation following PCL reconstruction has been recommended to allow the newly reconstructed ligament time to incorporate and thereby maximize the chance for stability.10 These recommendations were based on the transtibial technique and the incorporation of ligament into bone tunnels.