Posterior Cruciate Ligament Reconstruction Using a New Arthroscopic Tibial Inlay Double-bundle Technique

The treatment of posterior cruciate ligament injuries sparks debate in the field of sports medicine. Surgeons argue about the ideal technique for reconstruction (tibial inlay or transtibial) and the optimal graft design (single-bundle or double-bundle). We present a novel all-arthroscopic tibial inlay technique using a bifid bone-patellar tendon-bone allograft. Advantages of our technique include avoidance of the killer turn associated with the transtibial technique and restoration of biomechanical stability through bony fixation of the tibial inlay. In addition, our technique can be performed arthrosopically without the need for a posterior incision and capsulotomy. Our graft also restores the double-bundle anatomy of the native posterior cruciate ligament, which may improve stability more effectively than single-bundle techniques. With cadaveric studies, we have demonstrated that our technique restores stability as effectively as the traditional open tibial inlay technique. Results from our early experience are encouraging, and longer-term follow-up is in progress.