Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction: Overcoming the “Killer Turn”

Abstract

One of the most challenging arthroscopic surgical procedures is posterior cruciate ligament (PCL) reconstruction. PCL injuries account for 20% of all knee ligamenterelated injuries. These may be isolated or occur as part of poly-ligament injuries. With the possibility of PCL reconstruction with the all-inside technique, there has been a surge in interest in treating PCL injuries. With the PCL being one of the strongest ligaments in the body and a primary restraint to posterior translation of the tibia, the need for PCL reconstruction is being more and more recognized. Surgeons often find it difficult to negotiate the so-called killer turn while attempting arthroscopic PCL reconstruction. We describe the use of the GraftLink graft construct through the posteromedial portal in 7 patients (6 male and 1 female patient) with isolated PCL injuries, which we believe not only allows us to perform the all-inside PCL reconstruction but also does away with the difficulty of the killer turn encountered while performing the arthroscopic PCL reconstruction.

Postless Tape Augmentation for Posterior Cruciate Ligament Reconstruction

“…Another technical consideration when performing PCL reconstruction is managing the so-called “killer turn” at the proximal aperture of the tibial tunnel. 10 The “killer turn” causes difficulty with graft shuttling and has also been implicated in graft attenuation. 11 Our technique uses specific steps to mitigate both of these challenges.…”

Biomechanical comparison of proximal, distal, and anatomic tibial tunnel for transtibial posterior cruciate ligament reconstruction

“…Few studies revealed the optimal angle to place the tibial guide. 5,[27][28][29] Using a tibial aimer, the tunnels were made with an orientation of 50°to the tibial plateau with an external entry point approximately 1.5 cm medial to the tibial tubercle as previous study showed. 5 A guidewire (2.0-mm K-wire) was placed in the exit point of the PCL tibial tunnel (Figure 1).…”

Arthroscopic Remnant Preserving 3-Portal Posterior Cruciate Ligament Reconstruction With Reverse Passage of the Graft

“…Tibial attachment of the PCL is located ∼1 cm distal to the joint surface, resulting in a sharp angle, where the graft for the tibial tunnel exists, commonly known as “killer turn”. 5 , 6 , 7 Another disadvantage is the requirement of creating additional arthroscopic approaches, including trans-septal portal, which can cause difficulties for inexperienced surgeons. The authors present a surgical technique for arthroscopic remnant preserving 3-portal PCL reconstruction, with opposite to commonly described graft passage direction, which overcomes difficulties associated with the killer turn.…”