Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

Piedade, Sérgio Rocha; Laurito, Gerson Muraro; Migliorini, Filippo; Maffulli, Nicola

doi:10.1186/s13018-022-03495-6

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…When approaching these complex injuries, the primary strategy is to minimize additional tissue damage, even in a chronic injury. Over the last 20 years, after changing to PCL inlay reconstruction, we observed only minor knee effusions in our clinical practice, and the gain of knee range of movement was greater compared to the PCL tibial tunnel technique [ 14 ]. Hence, inlay reconstructions become our preferred technique to reconstruct the PCL.…”

Section: Discussionmentioning

confidence: 99%

“…The free end of the BTB graft was attached to a 5.0 Ethibond suture to be recovered. Using custom made instruments, we produced a tibial slot (10 mm long, 9 mm wide, and 10 mm deep) at the PCL tibial insertion [ 14 ]. The free end of the BTB graft was placed on the tibial slot and fixed using a bone pull-out press-fit 3.5 mm cortical screw and a washer, and the capsule sutured with the knee kept in full extension (Fig.…”

Section: Case Presentationmentioning

confidence: 99%

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Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury

Piedade,

Górios,

Spiezia

et al. 2024

J Orthop Surg Res

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A combined injury of the patellar tendon and both the anterior and posterior cruciate ligaments is disabling. It directly affects knee kinematics and biomechanics, presenting a considerable surgical challenge. In this complex and uncommon injury, decision-making should take into account the surgeon’s experience and consider one- or two-stage surgery, tendon graft, graft fixation, and rehabilitation protocol. This manuscript discusses the surgical approach based on a comprehensive understanding of the patellar tendon and bicruciate biomechanics to guide which structures should be reconstructed first, especially when a two-stage procedure is chosen.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury

Piedade,

Górios,

Spiezia

et al. 2024

J Orthop Surg Res

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“…The shaver or radiofrequency worked in the low approach and high approach could played the roles of pling, attracting and propping at the same time, so that the posterior medial compartment could have large operating space and a good surgical viewing without clearing the posterior septum and the stump. The speci c method in the process of positioning and making the tunnel, the shaver propped up the posterior capsule posteriorly, so that the neurovascular tissues were drawn toward the posterior part of the operating eld [32,33]. Taking the longitudinal axis of the posterior septum as a reference, the shaver was directed dorsally toward the posterior capsule, and a limited amount of synovial tissue was cleared between the posterior capsule and the stump of the PCL in the direction of the longitudinal axis of the posterior septum, with the side being propped up and cleaned up until it is revealed to be in re exion of the distal part of the posterior capsule [34,35].…”

Section: Advantage Of the Distal Re Exion Of The Posterior Capsule An...mentioning

confidence: 99%

Preservation of the posterior septum and stump for anatomical posterior cruciate ligament reconstruction of the tibial tunnel reference position

Chen,

Niu,

Jin

et al. 2023

Preprint

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Background: The purpose was to explore the anatomic position relationship and locate the lowest tunnel within the the PCL tibial insertion while intactly preserved the PCL stump, posterior septum and capsule. Methods: Twelve fresh unpaired adult human cadaveric knees were used to observe the spatial anatomical position between the PCL tibial insertion, posterior septum and posterior capsule. Then, the distal reflexion of the posterior capsule and the posterior septum were intactly preserved and used as references to search for the center of the tibial insertion (CP) and lowest tibial tunnel (SP). And measured the distance of the SP and CP points and PCL tibial insertion by anatomical measurements and CT scan. Results: In twelve specimens, the PCL tibial insertions were fully located within the posterior medial compartment of the knee. The distance of the CP from the tibial plateau articular surface was (6.5±0.2) mm, and the horizontal and vertical distances from the posterior septum were (5.9±0.3) and (5.4±0.4) mm, while the SP from them were (9.5±0.4), (4.3±0.3) and (4.1±0.3) mm, respectively. All the tibial tunnels established centered around the SP retained the intact posterior wall, which was (1.6±0.3) mm to the distal reflexion of the posterior capsule. The SP/CP was (17.6±5.6) % and (49.9±0.3) % closer to the inferior boundary, while (49.3±13.2) % and (33.9±6.8) % relative to the lateral boundary of the insertion. Conclusion: The PCL tibial insertion was located in the posterior medial compartment of the knee, with the posterior septum and distal reflexion of the posterior capsule as its lateral and inferior boundaries. Using the posterior septum and posterior capsule as reference marks, a low tibial tunnel with high repeatability can be established in the PCL tibial insertion without damaging the posterior septum.

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“…One study [ 12 ] explores patient characteristics and injury profiles, identifying susceptibility factors for complex injuries. Two studies [ 13 , 14 ] present surgical techniques for tibial inlay reconstruction and needle-arthroscopy-assisted arthroscopic PCL reconstruction to improve reproducibility and visualization. Two studies [ 15 , 16 ] discuss the controversy over reconstructive methods for chronic PCL injuries, advocating for nonoperative treatment in most cases, highlighting the rarity of PCL injuries in pediatric populations, and stressing the importance of optimal treatment to preserve knee function.…”

Section: Reviewmentioning

confidence: 99%

Clinical Effectiveness of Arthroscopy-Assisted Fixation in the Treatment of Avulsed Posterior Cruciate Ligament Injuries

Gawande,

Badge

2023

Cureus

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Avulsed posterior cruciate ligament (PCL) injuries are complex orthopedic challenges that require careful consideration and optimal management. Arthroscopy offers advantages, including smaller incisions, reduced soft tissue disruption, reduced postoperative pain, and improved visualization of intraarticular anatomy. Arthroscopy-assisted fixation results in superior clinical outcomes. Patient-specific factors, graft choice, and timing of surgery significantly impact outcomes. Rehabilitation is vital and requires a tailored approach to restore knee function. Biomechanically, arthroscopy-assisted fixation enhances joint stability and range of motion, reducing the risk of secondary injuries. Advancements in technology and surgical techniques further improve outcomes. Concomitant injuries and incorporation are essential considerations. Arthroscopy-assisted fixation is a recommended approach, but personalized care is crucial for successful recovery. Its precision in reattaching the PCL enhances joint stability and clinical results, aligning with outcomes seen in conventional procedures. Using biocompatible materials in fixation devices has significantly reduced the risk of allergic reactions or complications. This has allowed a faster and smoother recovery process for patients undergoing arthroscopy-assisted fixation. The incorporation of physical therapy and rehabilitation programs after surgery plays a vital role in restoring joint function and preventing muscle atrophy. The combination of advanced technology, surgical techniques, and personalized care has greatly improved the success rate of arthroscopy-assisted fixation procedures. Advancements in technology further improve patient outcomes, but each case should be individually assessed to determine the most appropriate treatment approach.

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Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

Cited by 8 publications

References 16 publications

Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury

Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury

Preservation of the posterior septum and stump for anatomical posterior cruciate ligament reconstruction of the tibial tunnel reference position

Clinical Effectiveness of Arthroscopy-Assisted Fixation in the Treatment of Avulsed Posterior Cruciate Ligament Injuries

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