An isolated posterior cruciate ligament (PCL) injury grade III (> 10 mm posterior step-off) in a 30-year-old athlete is confirmed on MRI. Associated posterolateral corner (PLC) structures are intact. After failure of 6 months of conservative rehabilitation, surgical reconstruction is planned. The preferred graft source and technique for isolated PCL reconstruction is:

• A Quadriceps tendon autograft with inlay (tibial inlay, non-tunnel) reconstruction technique ✓
• B Intra-articular hamstring autograft (semitendinosus–gracilis) via single-bundle transtibial technique
• C Lateral extra-articular tenodesis only
• D Patellar tendon autograft via anterior cruciate ligament tunnel placement

Explanation

PCL tibial inlay technique avoids the 'killer turn' (sharp angle of the PCL graft around the posterior tibial cortex with transtibial tunnels), which causes graft abrasion and failure. The tibial inlay technique (open posterior approach) anchors the graft directly into a trough at the tibial attachment site, eliminating the acute graft-tunnel angle. For large pedicle grafts requiring strong fixation, quadriceps tendon autograft provides substantial tissue. Hamstring grafts via transtibial tunnels are the most common but subject to the killer turn problem.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.