Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

Abstract

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

No Clinically Important Difference in Knee Scores or Instability Between Transtibial and Inlay Techniques for PCL Reconstruction: A Systematic Review

“…For this reason, we did not pool (meta-analyze) our data. In addition, heterogeneity among studies may have been attributable to differences in other factors that could affect clinical outcome after PCL reconstruction, including the use of a wide variety of autografts and allografts as graft sources, and variability in the use of fixation devices, which have been associated with differences in residual laxity in other studies [4,6]. Finally, not every included study rated every patient based on Tegner and Lysholm scores or the degree of posterior translation by stress radiographs and posterior drawer tests; the missing data may have affected the direction or robustness of our findings.…”

Pearls and Pitfalls of Single-bundle Transtibial Posterior Cruciate Ligament Reconstruction

“…3 A more recent concept in PCL tunnel fixation is aperture fixation. [32][33][34][35] As previously discussed, the killer turn can lead to graft failure and thinning and increased graft length in transtibial techniques. 22,23 Cadaveric studies showed that inlay techniques may eliminate these unwanted effects.…”

“…33 The clinical results of aperture fixation have been promising but consist of case series with small numbers. 34,35 Hermans et al 34 reconstructed the anterolateral bundle in 25 patients with PCL instability and pain using BPB autograft, hamstrings autograft, or Achilles allograft using interference screw fixation at the tunnel aperture. They reported good functional outcomes and a mean anteroposterior laxity difference of 2.1 mm between knees measured by KT-1000 (MEDmetric, San Diego, California) at 6-to 12-year follow-up.…”

“…They reported good functional outcomes and a mean anteroposterior laxity difference of 2.1 mm between knees measured by KT-1000 (MEDmetric, San Diego, California) at 6-to 12-year follow-up. 34 Gill et al 35 evaluated the results of aperture fixation using combined distal and proximal interference screws. In their small series of 10 patients with a minimum 1-year follow-up, they found improvement in knee scores and no difference .5 mm in anteroposterior displacement from the contralateral knee.…”

“…In their small series of 10 patients with a minimum 1-year follow-up, they found improvement in knee scores and no difference .5 mm in anteroposterior displacement from the contralateral knee. 35 This technique can be difficult because it requires the screw to transverse the length of the tunnel without exiting into the joint. In addition, a metal interference screw may become difficult to remove if revision surgery is necessary.…”