Posterior cruciate ligament reconstruction: current trends

Abstract

A survey was conducted of the Herodicus Society membership to assess the current status of treating posterior cruciate ligament (PCL) injuries and compared to a similar survey conducted in 1991. The survey addressed indications, graft choice, surgical technique, graft tensioning, and graft fixation. Seventy-eight active surgeons were sent a 34-question survey pertaining to isolated PCL injuries. The majority of respondents (78%) performed < or = 10 PCL reconstructions per year. The arthroscopic assisted with posteromedial portal technique was the most commonly used (49%). The tibial inlay/onlay technique was used by 15%, and 68% used the single femoral tunnel technique. The remainder used a double femoral tunnel technique. Allograft Achilles tendon was the most commonly selected graft for acute (43%) and chronic (50%) PCL reconstructions. An interference screw for femoral fixation was used 67% of the time. The majority of respondents (55%) tensioned their single bundle or anterolateral band of a double bundle in 71 degrees-90 degrees of flexion. A significant difference in technique was noted when comparing those who performed < or = 10 PCL reconstructions per year (group 1) versus > 10 PCL reconstructions per year (group 2). In group 1, 25% of surgeons used a double tunnel technique versus 59% of surgeons in group 2. The most common operative treatment for PCL injuries consisted of a single femoral tunnel with an Achilles tendon allograft. When compared to a similar survey conducted in 1991, the notable differences were a trend toward Achilles tendon allograft and the popularization of the double femoral tunnel and tibial inlay/onlay technique.