All-Inside Arthroscopic Posterior Cruciate Ligament (PCL) Reconstruction with Internal Brace Augmentation: Review on Residual Laxity at 3- and 6-Months Post Reconstruction via Posterior Drawer Test (PDT) Assessment and Lateral Radiograph Gravity Stress View
—A Case Series of 6 Patients in Orthopaedic Department, Hospital Raja Perempuan Zainab II Kelantan

Background: Recurrent posterior laxity remains a significant concern following posterior cruciate ligament (PCL) reconstruction. The all-inside arthroscopic technique with internal brace augmentation is emerging as a minimally invasive option with potential benefits in graft protection and early mobilization. Objective: This case series evaluates the residual posterior laxity at 3 and 6 months postoperatively in six patients who underwent all-inside PCL reconstruction with internal brace augmentation. The assessment was based on the Posterior Drawer Test (PDT) and lateral gravity stress view radiographs. By critically analysing recent literature and clinical findings, this paper seeks to contribute to improved diagnosis and management strategies for PCL reconstruction failures. Methods: Six patients (4 males, 2 females) with isolated or combined PCL injuries underwent arthroscopic all-inside PCL reconstruction with internal brace augmentation. Clinical evaluation using the PDT and radiological assessment via lateral gravity stress view were performed at 3 and 6 months. Residual posterior tibial translation >5 mm or increasing PDT grade was considered indicative of persistent laxity. Results: At 3 months, four patients had Grade 0 - 1 PDT and posterior translation ranging from 3.57 mm to 5.57 mm. At 6 months, five patients maintained or improved stability. One patient showed progression from Grade 1 to Grade 2 PDT and an increase in radiographic posterior translation from 5.57 mm to 6.96 mm, suggesting possible graft elongation or failure. Conclusion: All-inside PCL reconstruction with internal bracing demonstrated satisfactory short-term stability in most cases. However, residual laxity may still occur, emphasizing the importance of serial clinical and radiographic evaluation. Further studies are needed to validate long-term outcomes and refine surgical indications.