Double-Bundle “All-Inside” Posterior Cruciate Ligament Reconstruction

Abstract

The procedure for repairing the posterior cruciate ligament (PCL) has a steep learning curve and entails numerous difficult steps during surgery, because of the proximity of the neurovascular bundle, difficult passage of the graft through the posterior capsule, and risk of poor tibial fixation because of the long intramedullary trajectory of the graft. The use of instruments for retrograde reaming and a new device for adjustable cortical suspensory fixation allows for a safe, reproducible all-inside double-bundle PCL reconstruction by simplifying these difficult steps. We used anterior tibial allograft or hamstring autograft together with adjustable suspensory fixation devices that allow tensioning (after fixation) of the posterolateral bundle in extension and the anteromedial bundle in flexion.

Allografts in Posterior Cruciate Ligament Reconstructions

“…Precautions must be taken into account to avoid fracture of bone blocks. In multiligament reconstructions of the knee, one single complete Tibialis anterior is another allograft that has been investigated as an option for the reconstruction of the PCL and has already different doublebundle surgical techniques (Min et al 2011;Daniel Slullitel et al 2012). Tibialis posterior may also be used in double-bundle procedures with three strands (Kim et al 2004b).…”

“…Many authors favor double-bundle reconstructions which have also been described by all-inside technique (Yoon et al 2005;Slullitel et al 2012). Both the single-bundle and the double-bundle PCL reconstruction surgical techniques using allograft tissue provide successful results in the PCL-based multiligament-injured knee when evaluated with stress radiography, arthrometer measurements, and knee ligament rating scales (Fanelli et al 2012).…”

TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

“…7 Biomechanical studies have shown that the key determinant in controlling posterior tibial laxity in anatomic PCLR is the femoral tunnel placement on the medial wall and roof of the intercondylar notch. 18 Consequently, a trifurcate graft is the construct of choice for surgeons performing both open 19 and arthroscopic tibial inlay 9,20 PCLR.…”

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

“…"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.…”