Biomechanical analysis of posterior cruciate ligament reconstruction with aperture femoral fixation

Orthopedics. 2015 Jan;38(1):9-16. doi: 10.3928/01477447-20150105-50.


The goal of this study was to determine whether single-tunnel-double-bundle-equivalent posterior cruciate ligament (PCL) reconstruction using an aperture femoral fixation device better replicated normal knee kinematics than single-bundle reconstruction. Eight fresh-frozen human cadaver knees underwent arthroscopically assisted PCL reconstruction and were examined with a robotic testing system to assess knee joint kinematics under combinations of applied internal, neutral, and external rotational tibial torque and anteroposterior translational forces at 0°, 30°, 60°, 90°, and 120° flexion. Three conditions were tested: (1) intact PCL; (2) single-tunnel PCL reconstruction with anterolateral and posteromedial bundle fixation at 90°/90° (single bundle); and (3) 90°/0° (double-bundle equivalent), respectively. Posterior tibial translation was the primary outcome measure. Compared with the intact knee, double-bundle-equivalent reconstruction under external tibial torque allowed greater posterior translation across the flexion arc as a whole (P=.025) and at 30° flexion (P=.027) when results were stratified by flexion angle. No other kinematic differences were found with single-bundle or double-bundle-equivalent fixation, including mediolateral translation and both coupled and isolated tibial rotation (P>.05). Single-bundle PCL reconstruction closely approximated native knee rotational and translational kinematics, whereas double-bundle-equivalent reconstruction permitted increased posterior translation with applied external tibial torque, particularly at lower flexion angles. Single-bundle PCL reconstruction provides knee stability similar to the intact condition, making it a practical alternative to conventional double-bundle PCL reconstruction. The authors found that double-bundle-equivalent reconstruction provided no advantage to justify its clinical use.

MeSH terms

  • Adult
  • Aged
  • Biomechanical Phenomena / physiology
  • Female
  • Femur / surgery*
  • Humans
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery*
  • Male
  • Middle Aged
  • Orthopedic Procedures / methods*
  • Posterior Cruciate Ligament / physiopathology
  • Posterior Cruciate Ligament / surgery*
  • Range of Motion, Articular / physiology*
  • Reconstructive Surgical Procedures / methods*
  • Rotation
  • Torque