Sang Hak Lee1, Young-Bok Jung2, Sung-Min Rhee3, Han-Jun Lee3, Ho-Joong Jung3. 1. Center for Joint Diseases and Rheumatism, Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, South Korea. 2. Joint Center, Department of Orthopaedic Surgery, Hyundae General Hospital, 663 Jang hyeon-ri, Jinjeop-eup, Namyangju-si, Gyeonggi-do 472-865, South Korea. E-mail address: jungyb2000@paran.com. 3. Department of Orthopaedic Surgery, School of Medicine, Chung-Ang University, 224-1, Heukseok-dong, Dongjak-ku, Seoul 140-757, South Korea.
Abstract
INTRODUCTION: We present the surgical technique for arthroscopic revision posterior cruciate ligament (PCL) reconstruction with use of the modified tibial-inlay double-bundle method without a change of the patient's position from supine to prone. STEP 1 GRAFT PREPARATION: Create the Achilles tendon allograft as a tibial bone block with two femoral bundles. STEP 2 PATIENT POSITION: With the patient in the supine position, flexion, abduction, and external rotation of the hip and flexion of the knee 60° to 90° can provide easier access to the popliteal area. STEP 3 FEMORAL TUNNEL PREPARATION: Make anterolateral and posteromedial femoral tunnels in a shallow-shallow position using an outside-in technique for the anterolateral bundle and the inside-out technique for the posteromedial bundle. STEP 4 TIBIAL TUNNEL PREPARATION: Make the tibial tunnel with the patient supine with the hip flexed, abducted, and externally rotated and the knee flexed 60° to 90° to provide easier access to the popliteal area. STEP 5 GRAFT PASSAGE: Using a wire loop, pass the graft through the knee joint posterior to the intercondylar notch into the femoral tunnel. STEP 6 GRAFT FIXATION: Use a cannulated screw with a spiked washer to secure fixation of the bone block to the tibia. STEP 7 POSTOPERATIVE REHABILITATION: Rehabilitation after a PCL repair is generally more conservative than the accelerated rehabilitation used after an ACL repair. RESULTS: In our study, twenty-two patients (twenty men and two women; mean age, 37.4 years) were treated with revision PCL reconstruction performed with the described technique and followed for a mean of 39.6 months (range, twenty-four to seventy-two months)14.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We present the surgical technique for arthroscopic revision posterior cruciate ligament (PCL) reconstruction with use of the modified tibial-inlay double-bundle method without a change of the patient's position from supine to prone. STEP 1 GRAFT PREPARATION: Create the Achilles tendon allograft as a tibial bone block with two femoral bundles. STEP 2 PATIENT POSITION: With the patient in the supine position, flexion, abduction, and external rotation of the hip and flexion of the knee 60° to 90° can provide easier access to the popliteal area. STEP 3 FEMORAL TUNNEL PREPARATION: Make anterolateral and posteromedial femoral tunnels in a shallow-shallow position using an outside-in technique for the anterolateral bundle and the inside-out technique for the posteromedial bundle. STEP 4 TIBIAL TUNNEL PREPARATION: Make the tibial tunnel with the patient supine with the hip flexed, abducted, and externally rotated and the knee flexed 60° to 90° to provide easier access to the popliteal area. STEP 5 GRAFT PASSAGE: Using a wire loop, pass the graft through the knee joint posterior to the intercondylar notch into the femoral tunnel. STEP 6 GRAFT FIXATION: Use a cannulated screw with a spiked washer to secure fixation of the bone block to the tibia. STEP 7 POSTOPERATIVE REHABILITATION: Rehabilitation after a PCL repair is generally more conservative than the accelerated rehabilitation used after an ACL repair. RESULTS: In our study, twenty-two patients (twenty men and two women; mean age, 37.4 years) were treated with revision PCL reconstruction performed with the described technique and followed for a mean of 39.6 months (range, twenty-four to seventy-two months)14.IndicationsContraindicationsPitfalls & Challenges.
Authors: Philipp W Winkler; Bálint Zsidai; Nyaluma N Wagala; Jonathan D Hughes; Alexandra Horvath; Eric Hamrin Senorski; Kristian Samuelsson; Volker Musahl Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-10-30 Impact factor: 4.342