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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