Arthroscopic Double-Bundle Posterior Cruciate Ligament Reconstruction Surgical Technique

ABSTRACT

The keys to successful posterior cruciate ligament (PCL) reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and use the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single-bundle and double-bundle arthroscopic transtibial tunnel PCL reconstruction based on stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

KEYWORDS

Posterior cruciate ligament - double bundle - allograft - transtibial tunnel technique - mechanical graft tensioning boot.

REFERENCES

• 1 Noyes F R, Barber-Westin S D. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations.  Am J Sports Med. 2005;  33 646-654
• 2 Robinson J R, Bull A MJ, Thomas R R, Amis A A. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity.  Am J Sports Med. 2006;  34 1815-1823
• 3 Sekiya J K, Haemmerle M J, Stabile K J, Vogrin T M, Harner C D. Biomechanical analysis of a combined double-bundle posterior cruciate ligament and posterolateral corner reconstruction.  Am J Sports Med. 2005;  33 360-369
• 4 Fanelli G C, Giannotti B F, Edson C J. The posterior cruciate ligament arthroscopic evaluation and treatment.  Arthroscopy. 1994;  10 673-688
• 5 Fanelli G C, Giannotti B F, Edson C J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.  Arthroscopy. 1996;  12 5-14
• 6 Fanelli G C, Giannotti B F, Edson C J. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.  Arthroscopy. 1996;  12 521-530
• 7 Fanelli G C, Feldmann D D. Management of combined ACL/PCL/posterolateral complex injuries of the knee.  Oper Tech Sports Med. 1999;  7 143-149
• 8 Fanelli G C, Edson C J. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up.  Arthroscopy. 2002;  18 703-714
• 9 Fanelli G C. Surgical treatment of ACL-PCL-medial side-lateral side injuries of the knee.  Oper Tech Sports Med. 2003;  11 263-274
• 10 Fanelli G C, Edson C J. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up.  Arthroscopy. 2004;  20 339-345
• 11 Fanelli G C, Orcutt D R, Edson C J. The multiple-ligament injured knee: evaluation, treatment, and results.  Arthroscopy. 2005;  21 471-486
• 12 Fanelli G C, Edson C J, Orcutt D R, Harris J D, Zijerdi D. Treatment of combined ACL PCL medial lateral side injuries of the knee.  J Knee Surg. 2005;  28 240-248
• 13 Fanelli G C, Edson C J, Reinheimer K N. Posterior cruciate ligament reconstruction: transtibial tunnel surgical technique.  Orthop Today.. 2007;  27 40-46
• 14 Fanelli G C, Edson C J, Reinheimer K N, Garofalo R. Posterior cruciate ligament and posterolateral corner reconstruction.  Sports Med Arthrosc. 2007;  15 168-175
• 15 Fanelli G C. Rationale and Surgical Technique for PCL and Multiple Knee Ligament Reconstruction. Surgical Technique Guide. Warsaw, IN; Biomet Sports Medicine, Inc. 2008
• 16 Fanelli G C, Edson C J, Reinheimer K N, Beck J. Arthroscopic single bundle v double bundle posterior cruciate ligament reconstruction.  Arthroscopy. 2008;  24(6, Suppl) e26
• 17 Fanelli G C. Posterior cruciate ligament rehabilitation: how slow should we go?.  Arthroscopy. 2008;  24 234-235
• 18 Fanelli G C, Boyd J L, Heckler M W. How I manage PCL injuries.  Oper Tech Sports Med. 2009;  17 175-193
• 19 Fanelli G C, Beck J D, Edson C J. Comparison of arthroscopic single bundle and double bundle posterior cruciate ligament reconstruction using allograft tissue in multiple ligament knee injuries: two to six year follow up in ninety consecutive cases. In press
• 20 Fanelli G C, Beck J D, Edson C J. Double bundle posterior cruciate ligament reconstruction: surgical technique and results.  Sports Med Arthrosc. 2010;  18 , In press
• 21 Giffin J R, Haemmerle M J, Vogrin T M, Harner C D. Single- versus double-bundle PCL reconstruction: a biomechanical analysis.  J Knee Surg. 2002;  15 114-120
• 22 Fanelli G C. Arthroscopic evaluation of the PCL. In: Fanelli GC Posterior Cruciate Ligament Injuries. A Guide To Practical Management. New York, NY; Springer-Verlag 2001: 95-108