An accessory portal for posterior cruciate ligament tibial insertion visualization

Increasing the Distance between the Posterior Cruciate Ligament and the Popliteal Neurovascular Bundle by a Limited Posterior Capsular Release during Arthroscopic Transtibial Posterior Cruciate Ligament Reconstruction

“…Despite the fact that the potential for this complication is widely understood, there exists limited objective guidelines to aid surgeons in avoiding it. 5,10,12,19 This study reveals the effect of arthroscopic limited posterior capsular release using a posterior trans-septal portal to potentially minimize the risk of serious neurovascular injury.…”

Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

“…The insertion of the PCL on the posterior tibial upslope can be clearly visualized surgically at the time of reconstruction by having the appropriate amount of soft tissue and PCL remnant debridement. Various techniques such as the utilization of a 70° arthroscope, posterolateral portal approach, a midline trans-patellar tendon approach, or a posterior trans-septal portal approach technique have been shown from previous studies to have a better visualization of the retained PCL remnant [5], [6], [10], [14], [15], [16]. However, there are potential surgery associated morbidities related to additional portals techniques as well as the implementation of variable angle arthroscopic techniques.…”

“…These were related to several factors, including intercondylar notch mechanical blockage, inexperienced surgeon, and degenerative joint disease cases. The failure of triangulation of the arthroscope and the instrument has been acknowledged by many arthroscopic surgeons to be the cause of unsuccessful arthroscopic procedures in certain areas of the posterior compartment [5], [6], [10], [14], [15], [16]. The previous study stated that PCL reconstruction with PCL remnant preservation gave good healing capacity and possible proprioception [10], [8].…”

Bicruciate Knee Ligament Reconstruction Using 4 All-Anterior Arthroscopic Portals

“…3,4 With the use of posterior portals, there is the potential for increased operative time as well as added morbidity in the creation of these portals. 7,8 Specific risks of the posteromedial portal have been described, including injury to the saphenous vein and/or nerve. 5,6 Our method describes a bicruciate reconstruction using 4 anterior portals while avoiding the use of a posterior portal.…”

“…[3][4][5] The use of an accessory posteromedial portal has some inherent risks and potential for increase in operative time. [5][6][7][8] We describe our bicruciate knee ligament reconstruction using 4 allanterior portals including a high anteromedial (AM), high anterolateral (AL), low AM, and low AL portals. We focus on the PCL aspect of the reconstruction in the technique described below.…”