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Scientific Articles   |    
Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement
Robert F. LaPrade, MD, PhD1; Casey M. Pierce, MD1
1 The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657. E-mail address for R.F. LaPrade: drlaprade@sprivail.org. E-mail address for C.M. Pierce: casey.pierce@sprivail.org
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Based on an original article: J Bone Joint Surg Am. 2011;93:1773-80.



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. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. 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 © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Jan 11;02(01):1-14. doi: 10.2106/JBJS.ST.K.00025
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Extract

Overview
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

Indications

Contraindications

Pitfalls & Challenges

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    References

    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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