Non-hardware Posterior Cruciate Ligament Reconstruction Using Knot/Press-fit Technique With Periosteum-Enveloped Hamstrings Tendon Autograft

Background: Several posterior cruciate ligament reconstruction procedures have been proposed to manage ruptures. Purpose: This study was intended to present the clinical results of non-hardware reconstruction of posterior cruciate ligament using a knot/press-fit technique with periosteum-enveloped autogenous hamstring tendons. Study Design: Case series; Level of evidence, 4. Methods: This arthroscopically assisted technique was used in 33 patients with posterior cruciate ligament ruptures. In this non-hardware technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. Each loop was enveloped in periosteum. After passing a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (knotted grafts lodging in the bottleneck of the femoral tunnel). Simultaneously, the intra-articular opening of the tibial tunnel was filled with the periosteum-enveloped portion of the graft. A tie with Mersilene tape over a bone bridge for each tendon loop was used for tibial fixation. Results: The average follow-up was 35 months (range, 24-60 months). Clinical assessments included Tegner score, Lysholm knee score, International Knee Documentation Committee scores, thigh muscle assessment, and radiographic evaluation. The stress radiography results for posterior displacement changed from 13.7 +/- 2.1 mm preoperatively to 4.8 +/- 1.1 mm postoperatively. Average preinjury Tegner score was 5.9 (range, 3-9), decreasing to 2.9 (range, 2-5) preoperatively and increasing to 5.2 (range, 2-9) postoperatively. The Lysholm score increased from 58.5 +/- 5.2 to 94.2 +/- 4.1 (P < .01). Finally, 26 patients (89.7%) were assessed as nearly normal by International Knee Documentation Committee guidelines. Conclusion: The study revealed satisfactory clinical subjective and objective results at a minimum of 2 years' follow-up. Without using hardware, this alternative technique has the advantage of no need for removal of hardware and potentially easier magnetic resonance imaging interpretation and revision surgery.