Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement.

INTRODUCTION: As the varied results seen after posterior cruciate ligament (PCL) reconstructions might be due to surgical techniques that fail to reconstruct both functional bundles of the PCL and that injure the vastus medialis obliquus muscle, we developed a technique to address these problems and thus improve patient outcomes. STEP 1 EXAMINE UNDER ANESTHESIA: Assess range of motion and patellofemoral stability; perform stress tests, Lachman and pseudo-Lachman tests, pivot shift test, drawer tests, reverse pivot shift test, and dial test. STEP 2 PERFORM ARTHROSCOPY: Preserve any remnants of PCL at anterolateral and posteromedial bundle attachment sites to promote vascular healing. STEP 3 DRILL TIBIAL GUIDEPIN: Guidepin enters tibia at, roughly, 45° angle and 6 cm distal to joint line, midway between anterior tibial crest and posteromedial tibial border. STEP 4 PREPARE GRAFTS: Use Achilles tendon allograft for anterolateral bundle and semitendinosus or tibialis anterior allograft for posteromedial bundle. STEP 5 DRILL TUNNELS: Guidepin position should be slightly lateral to midline between apices of medial and lateral tibial eminences on anteroposterior radiograph and approximately 7 mm proximal to "champagne-glass drop-off" on lateral radiograph. STEP 6 PLACE AND SECURE GRAFTS IN FEMUR AND TIBIA: Tug hard on grafts through anterolateral arthroscopic portal to verify that they are secured within the femoral tunnel. STEP 7 POSTOPERATIVE CARE: Manage knee motion for first six weeks by prone knee flexion to counteract deleterious effects of gravity on reconstruction.
RESULTS: In a cohort of thirty-nine total patients, thirty-three males and six females, with an average age of thirty-three years, seven isolated PCL reconstructions and thirty-two combined knee reconstructions were performed. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.