Anatomic posterior cruciate ligament reconstruction: State of the Art

Chahla, Jorge; Bormann, Richard von; Engebretsen, Lars; LaPrade, Robert F.

doi:10.1136/jisakos-2016-000078

Cited by 17 publications

(13 citation statements)

References 77 publications

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“…19 In this regard, magnetic resonance imaging (MRI) is less sensitive for the evaluation of chronic PCL injuries because the signal intensity and shape of the torn PCL can be restored; however, residual laxity can be present and stress radiographs therefore play a fundamental role. 11 PCLR was recently reported to produce more satisfactory and consistent knee stability when compared with nonoperative treatment. 1 While improvements in singlebundle PCLR tunnel placement, fixation type, and optimal graft fixation angles have been achieved, biomechanical and clinical studies demonstrated residual laxity after single-bundle PCLR.…”

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confidence: 99%

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Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

et al. 2018

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confidence: 99%

“…Posterior cruciate ligament (PCL) injuries are increasingly being recognized as a cause of morbidity and reduced function. 11 These injuries decrease joint longevity by causing degenerative changes when left untreated. 19,29 These factors have led to an increased focus on and improvement in surgical treatment of these injuries.…”

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confidence: 99%

Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

et al. 2018

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“…The current trend in PCL repair is to reconstruct its 2 functional bundles, the larger AL and the smaller PM, aimed as close as possible to their respective anatomic insertions. 9,12 The use of instruments for retrograde reaming and devices for adjustable cortical suspensory fixation allows for a safe, reproducible allinside BCL reconstruction by simplifying the difficult steps of a double-bundle PCL reconstruction. The popliteal pedicle is at risk of injury during drilling of the PCL tibial tunnel because of its location within a centimeter of the PCL tibial footprint.…”

Section: Discussionmentioning

confidence: 99%

“…Tensioning of the AL and PM PCL bundles grafts are then performed by pulling on the femoral ends. The AL PCL bundle is tensioned with the knee placed at 90 of flexion and the PM PCL bundle is tensioned with the knee placed between 0 and 30 of flexion according to its isometric behavior, 11,12 while reducing the posterior drawer (Fig 4).…”

Section: Graft Passage Fixation and Tensioningmentioning

confidence: 99%

All-Inside Bicruciate Ligament Reconstruction Technique: A Focus on Graft Tensioning Sequence

Thaunat

Clowez

Murphy

et al. 2017

Arthroscopy Techniques

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Bicruciate ligament (BCL) reconstructions are challenging procedures. One of the main operative goals is to stabilize the knee in the correct anterior-posterior position. We present an all-inside arthroscopic BCL reconstruction technique using hamstring tendon grafts. Ipsilateral semitendinosus (ST) and gracilis tendons are used for TriLink (Arthrex, Naples, FL) double-bundle posterior cruciate ligament (PCL) reconstruction and contralateral ST tendon is used for GraftLink (Arthrex) single-bundle anterior cruciate ligament (ACL) reconstruction. The use of instruments for retrograde reaming and devices for adjustable cortical suspensory fixation allows for a safe, reproducible all-inside BCL reconstruction by simplifying these difficult steps. To minimize the risk of anterior-posterior malposition, the ACL graft is first tensioned with the knee in full extension, ensuring a neutral anteroposterior positioning of the tibia under the femur. The PCL anterolateral bundle can then be independently tensioned with the knee at 90 of flexion, and the posteromedial bundle at 30 of flexion, while applying an anterior translation to the tibia to reduce the posterior drawer without any risk of overcorrection. The purpose of this Technical Note was to describe an all-inside BCL reconstruction with a specific focus on the graft tensioning sequence. Bicruciate ligament (BCL) injuries are uncommon, and surgical procedures for multiligament injuries of the knee are very demanding. 1For BCL reconstructions, the main operative concern is to restore the correct anterior-posterior parameters of the knee. Most of the other challenges are due to PCL reconstruction; tibial footprint visualization, neurovascular damage risk when drilling the tibial tunnel, tibial fixation in the long axis of the tibia, and the need to tension the anterolateral (AL) and posteromedial (PM) bundles in flexion and extension, respectively. 2As arthroscopic techniques, instrumentation, and knowledge on the biomechanics evolve, many of the technical difficulties at surgery lessen and results relating to knee stability improve. "All-inside" techniques for cruciate ligament reconstruction have recently been described.3,4 Our purpose is to describe an all-inside technique for BCL reconstruction, using ipsilateral semitendinosus (ST) and gracilis tendons for double-bundle posterior cruciate ligament (PCL) reconstruction and contralateral ST tendon for GraftLink (Arthrex, Naples, FL) single-bundle anterior cruciate ligament (ACL) reconstruction. This is a simplified all-inside operative procedure for the PCL reconstruction with 2 anatomically placed femoral tunnels and a single tibial tunnel. The hamstring tendons are attached to 3 adjustable suspensory fixation devices in a Y-shaped trifurcate configuration. We also describe in this article the different steps for graft tensioning during BCL reconstruction to ensure optimal stability of the injured joint without restricting a normal physiological range of motion.

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“…3 For the PCL injury, surgery is indicated if it is accompanied with multiple ligament injuries such as PLC knee injuries. 6 The treatment of PLC knee injuries has always been a challenging topic due to the low healing capacity of PLC injuries. 7 The use of graft for multiple ligament reconstruction is still in debate all around the world.…”

Section: Introductionmentioning

confidence: 99%

Posterior cruciate ligament and posterolateral corner reconstruction in patient with multiple ligament injury of the knee: a case report

Aryana¹,

Kermawan²

2020

Int J Res Med Sci

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The treatment of posterolateral corner (PLC) knee injuries has always been a challenging topic due to the low healing capacity of PLC injuries. Authors performed posterior cruciate ligament reconstruction using semitendinosus tendon graft and reconstruction procedure of PLC using free gracilis tendon graft with LaPrade technique in a patient with multiple ligament injury of the knee. A 36-years-old male patient complained of pain on his right knee. On physical examination, the posterior drawer test, dial test, and varus stress test were positive. Magnetic resonance imaging (MRI) on right knee showed that the posterior cruciate ligament (PCL), lateral collateral ligament, and popliteofibular ligament were injured but the popliteus tendon was still intact. A semitendinosus tendon was harvested from the ipsilateral pes anserinus region for posterior cruciate ligament reconstruction. Posterolateral corner reconstruction was done by grafting two gracilis tendons from ipsilateral and contralateral sides using LaPrade technique. The semitendinosus tendon graft had been used for PCL reconstruction in some cases besides the hamstring tendon graft and provides a clinically evident reduction in symptoms and restores satisfactory stability. The LaPrade technique for PLC reconstruction was one of the earliest descriptions of a surgical option to recreate the anatomy of the three main static stabilizers of the PLC. We reported a reconstructive procedure for PCL and PLC injury of the knee by using semitendinosus and gracilis tendon graft with LaPrade technique.

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Anatomic posterior cruciate ligament reconstruction: State of the Art

Cited by 17 publications

References 77 publications

Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions

All-Inside Bicruciate Ligament Reconstruction Technique: A Focus on Graft Tensioning Sequence

Posterior cruciate ligament and posterolateral corner reconstruction in patient with multiple ligament injury of the knee: a case report

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