University of Virginia Health System

U.VA. RESEARCHERS FIND MORE EFFECTIVE PROCEDURE FOR KNEE LIGAMENT RECONSTRUCTION

Thousands of people suffer posterior cruciate ligament (PCL) injuries every year from playing contact sports such as football, lacrosse and hockey, or because of car accidents and falls. In the past, PCL reconstruction was not as successful as other types of knee ligament surgery. But now, University of Virginia orthopedic researchers have developed and tested a more effective technique for reconstruction.

The new approach, called the tibial inlay technique, is described in study results published in this month's Journal of Knee Surgery. The study was led by principal investigator Dr. Mark Miller, associate professor of orthopedics and co-director of sports medicine at U.Va.

The tibial inlay technique involves making an incision in the back of the knee and retracting the calf muscle, Miller said. The muscle and tendons are pulled to the outside and used as a security blanket to protect vital vessels and nerves. A 'trough' is then fashioned in the back of the knee. This allows the PCL graft to be placed directly into the 'trough', secured with a screw, and then passed into position in the knee.

In the past, PCL reconstruction was not as successful a procedure as anterior cruciate ligament (ACL) reconstruction, which involves the ligament in the front and middle of the knee. A reason for this is doctors have always avoided using the most direct route to the PCL, which involves going through the back of the knee, where the femoral arteries and nerves are located. The conventional PCL approach from the front of the knee also has pitfalls, such as an increased risk of graft failure and less stability of the knee over time, Miller said.

The PCL study detailed in the journal, which was conducted on eight cadaver specimens, involved injecting the arteries of the legs with dye and using X-ray images to show that the procedure could safely avoid the femoral arteries and nerves by about an inch. Miller believes this procedure will lead to a higher success rate for patients suffering from PCL injuries.

This technique should maintain the stability of the knee that we obtain in the operating room, he said. And so when we look in the operating room at the two procedures I'd say both cases are similar, but two, three or six months later the tibial inlay technique remains more stable. The other types of grafts have stretched out, which can lead to future injuries.

Miller, who has been at U.Va. for two years, has performed this procedure in approximately 100 cases, of which 15 to 20 have been at Virginia.

August 15, 2002