Comparison of Anatomic Versus Nonanatomic Placement of Femoral Tunnels in Achilles Double-Bundle Posterior Cruciate Ligament Reconstruction

Purpose: In this study, we compared femoral tunnel pairs that differ by group in a double-bundle Achilles tendon allograft posterior cruciate ligament (PCL) reconstruction. Methods: Group 1 patients had femoral tunnels drilled nearly within the footprint area most proximal and most distal to the axis of the femur. Group 2 patients had femoral tunnels drilled eccentrically within the footprint along an axis nearly perpendicular to the axis of the femur. Patient assessments were made subjectively with preoperative and postoperative assessments of Lysholm rating scale, posterior drawer test, and dial test. Objective assessments used range of motion and quadriceps circumference. Group 1 contained 7 patients with a mean age of 32 years (range, 20 to 46 years). Group 2 contained 10 patients with a mean age of 32 years (range, 20 to 46 years). Results: Group 2 patients had significantly less posterior laxity than group 1 patients. Postoperatively, 6 patients in group 1 (86%) had a positive posterior drawer test compared with 3 in group 2 (30%). Rotational laxity was identified by dial test results postoperatively in 3 patients in group 1 (43%) compared with 0% in group 2. Extension deficit occurred in 2 patients in group 1 (29%) and 1 patient in group 2 (10%). Flexion deficit occurred more than twice as frequently in group 1 (71% [5 patients]) than in group 2 (30% [3 patients]). There were no statistically significant differences for other comparisons. Conclusions: The clinical outcomes support the group 2 method with femoral tunnel placement at the anterior-most and posterior-most portions of the femoral PCL insertion. The group 2 procedure described in this study incorporates advanced principles for successful outcomes with Achilles double-bundle PCL reconstruction. Level of Evidence: Level III, case-control study.