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Revision Posterior Cruciate Ligament Reconstruction with a Modified Tibial-Inlay Double-Bundle Technique
Sang Hak Lee, MD1; Young-Bok Jung, MD2; Sung-Min Rhee, MD3; Han-Jun Lee, MD3; Ho-Joong Jung, MD3
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
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Based on an original article: J Bone Joint Surg Am. 2012 Mar 21;94(6):516-22.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2014 Jan 08;4(1):e1 1-6. doi: 10.2106/JBJS.ST.M.00059
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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.


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.



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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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