MedSport-Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Arthroscopy. 2011 Sep;27(9):1289-95. doi: 10.1016/j.arthro.2011.04.007. Epub 2011 Aug 10.
The optimal method of posterior cruciate ligament (PCL) reconstruction is not known. The purpose was to evaluate the biomechanical and clinical literature comparing open tibial inlay and arthroscopic transtibial PCL reconstructions and determine which method of reconstruction is superior.
A systematic review of the literature was performed on PubMed. Biomechanical and clinical studies comparing the outcomes of open tibial inlay and arthroscopic transtibial PCL reconstructions were selected and reviewed.
Biomechanical studies evaluating posterior stability found no difference or increased stability with open inlay reconstruction. Graft degradation at the killer turn after arthroscopic transtibial reconstruction was described in some of the biomechanical studies. Biomechanical studies found no significant difference in graft forces after cyclic loading between the 2 groups. Biomechanical studies were influenced by methodologic limitations of graft fixation, power analysis, graft tensioning protocol, and magnitude of load applied for cyclic loading. Clinical studies with some methodologic limitations found no significant difference in maintaining posterior stability between the 2 reconstruction groups at short-term follow-up.
The advantage of open inlay or arthroscopic transtibial PCL reconstruction techniques remains uncertain in the setting of conflicting biomechanical studies, with notable limitations in clinical studies. The arthroscopic tibial inlay technique may provide benefits of both open inlay and transtibial reconstruction techniques and comparable stability to the conventional PCL reconstruction methods according to several biomechanical studies.
Level IV, systematic review.
后交叉韧带（PCL）重建的最佳方法尚不清楚。本研究旨在评估比较经皮胫骨隧道入路（open tibial inlay）和关节镜下经胫骨隧道PCL 重建的生物力学和临床文献，并确定哪种重建方法更优。
对 PubMed 进行了系统的文献回顾。选择并回顾了比较经皮胫骨隧道入路和关节镜下经胫骨隧道 PCL 重建的生物力学和临床研究。
评估后向稳定性的生物力学研究发现，开放式胫骨插入重建并没有差异或增加稳定性。一些生物力学研究描述了关节镜下经胫骨隧道重建后在“杀手弯”处的移植物退化。循环加载后，两组间移植物力无显著差异。生物力学研究受到移植物固定方法学限制、功率分析、移植物张紧方案以及循环加载应用的负荷大小的影响。具有一定方法学局限性的临床研究发现，两组重建在短期随访中后向稳定性没有显著差异。
在存在相互矛盾的生物力学研究的情况下，开放式胫骨插入或关节镜下胫骨隧道 PCL 重建技术的优势仍不确定，临床研究也存在明显的局限性。根据几项生物力学研究，关节镜下胫骨插入技术可能具有开放式胫骨插入和经胫骨隧道重建技术的优点，并且与传统 PCL 重建方法具有相当的稳定性。
IV 级，系统评价。
