Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: A systematic review

Background: Reconstruction of the posterior cruciate ligament has traditionally been performed using an arthroscopically assisted single-bundle transtibial technique. Unfortunately, clinical studies evaluating this procedure are rare. In addition, there are no pooled analyses evaluating the effectiveness of this procedure for isolated posterior cruciate ligament tears. Hypothesis: Patients who undergo arthroscopically assisted, single-bundle, transtibial posterior cruciate ligament reconstruction will exhibit subjective improvement in knee function despite persistent objective knee laxity. Study Design: Systematic review. Methods: A structured literature search was performed to identify those clinical studies assessing the results of an arthroscopically assisted single-bundle transtibial posterior cruciate ligament reconstruction for isolated posterior cruciate ligament tears. The published data meeting the inclusion criteria were systematically reviewed with an emphasis on residual posterior laxity, subjective and objective functional outcome, activity level, patient satisfaction, incidence of osteoarthritis, and postoperative complications. Results: A total of 10 studies were identified that met the inclusion criteria. Mean postoperative instrumented posterior knee laxity varied from 1.96 mm to 5.90 mm, which was considerably improved from preoperative values (range, 8.38-12.3 mm). The range of mean values of the Lysholm knee scores was 81 to 100 points. The overall International Knee Documentation Committee rating was categorized as ''normal'' or ''nearly normal'' in 75% of patients and the mean Tegner activity score varied from 4.7 to 6.3 points. Degenerative osteoarthritis was frequently noted at the time of the most recent follow-up. There were few complications reported. Conclusion: Arthroscopically assisted single-bundle transtibial posterior cruciate ligament reconstruction for isolated posterior cruciate ligament tears can improve posterior knee laxity by 1 grade, although this procedure does not reliably restore normal knee stability. Return to recreational and athletic activity was predictable, with 75% of patients exhibiting a normal or nearly normal objective outcome, although degenerative osteoarthritis was not prevented by this procedure.