Journal: Arthroscopy Techniques
Article Title: Posterior Cruciate Ligament Reconstruction with Retrograde Femoral Technique, Posterior Trans-septal Portal and Full Tibial Tunnel
doi: 10.1016/j.eats.2017.03.026
Figure Lengend Snippet: Posterior cruciate ligament reconstruction with retrograde femoral technique, posterior trans-septal portal, and full tibial tunnel. The right knee is shown in supine position with the knee flexed to 90°. When the PCL was ruptured, the ACL appeared pseudo-lax and tightened during an anterior drawer test of the tibia. After making the posteromedial portal, a posterolateral portal was made using a switching stick inserted into the posteromedial portal to posterolateral compartment with the penetration of the posterior septum and established on the palpable point of the switching stick. A trans-septal portal was made by connecting the posteromedial and posterolateral portal. Once the posteromedial and posterolateral portals were established, PCL remnants were debrided from the tibial and femoral footprint. The guide pin was targeted toward the lateral portion of the PCL stump. The tibial tunnel was made using a reamer. A twisted wire was then passed through the tibial tunnel, and it brought out the anteromedial portal to pass the PCL graft easily. The femoral tunnel was created using an out-side in, retro-socket technique. The tip of the guide hook was targeted at the central portion of the footprint of the PCL remnant. After the tip of the FlipCutter was inserted in the joint space, the femoral guide was removed from the anteromedial portal and the drill sleeve was pushed into the bone lightly. The blue hub was pushed forward to flip the blade into cutting position. The socket was formed at least 30 mm deep with clockwise drilling. The FlipCutter was removed by straightening the blade. The looped wire used for graft passage was inserted through the drill sleeve and picked out to the anteromedial portal. PCL remnants were debrided from the femoral footprint for easy graft passage (PCL 30). The femoral socket was safely made without complications (PCL 21), and the walls of the tunnel were smooth and consistent. The graft passage was done stage by stage. The prepared graft was first passed into the knee joint through the tibial tunnel using twisted wire under direct arthroscopic vision in the anterolateral portal. Next, the tendon portion of the graft was passed into the femoral tunnel by the aid of a femoral wire shuttle. The TightRope button should be directly visualized to pass the femoral socket fluently. The graft was advanced by pulling the tensioning strands in the same direction of graft advancement using the TightRope RT. The graft was tensioned and fixed on the tibial side with bioabsorbable interference screws, and the free ends of the graft were fixed with a spiked washer and a screw under manual tension. Final tensioning of the grafted PCL was performed. (ACL, anterior cruciate ligament; PCL, posterior cruciate ligament.)
Article Snippet: Tibial fixation was achieved with a long bio-absorbable interference screw (BioComposite screw; Arthrex) that was oversized by 0.5 to 1 mm with respect to the tibial tunnel diameter.
Techniques:
