Using soft tissue graft and tunneloc tibial fixation with toggleloc fixation device with ziploop technology. Most people think of the tibiofemoral joint when thinking of the knee. Apr 16, 2018 arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers. Arthroscopic ligament repair and reconstruction request pdf.
Recent advances have included doublebundle pcl, arthroscopic inlay, and allinside techniques. Sagittal t1 weighted mri showing a complete intrasubstance posterior cruciate ligament pcl tear. Pdf arthroscopic pcl reconstruction with a novel all. Arthroscopic allinside posterior cruciate ligament. Determine the important steps in the surgical management of the pcl reconstruction. Posterior cruciate ligament reconstruction using singlebundle patella tendon graft with tibial inlay fixation. Tibial inlay posterior cruciate ligament pcl reconstruction was developed to avoid killer turn of the tibial tunnel. A biomechanical comparison of posterior cruciate ligament reconstruction using single and doublebundle tibial inlay techniques. This technical note presents an anatomic, singlebundle, allinside pcl reconstruction with an anterior tibialis allograft graftlink construct. Midterm clinical outcome of combined posterior cruciate. A series of 21 patients with a mean followup of 29months. This multicenter prospective study was undertaken from august 2010 to december 2014, after approval from the local ethical committee.
Arthroscopic debridement chondroplastyloose bodyforeign body removal 6 synovectomy 6 meniscectomy or meniscal repair 7 meniscal allograft transplantation 8 anterior cruciate ligament acl reconstruction 9 posterior cruciate ligament pcl reconstruction 10 mediallateral collateral ligament mcllcl repairreconstruction 10. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Comparison of tibial graft fixation between simulated. Allinside posterior cruciate ligament reconstruction with. Use an arthroscopic leg holder proximally on the thigh just distal to the tourniquet and flex the end of the table to allow flexion of the knee up to 120 degrees. Arthroscopic pcl reconstruction surgery demo vumedi. Arthroscopic pcl reconstruction with a novel allinside femoral fixation device. Arthroscopic posterior cruciate ligament tibial inlay. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of. Pdf arthroscopic pcl reconstruction with a novel allinside. We report an arthroscopic tibial inlay pcl reconstruction technique to avoid morbidity from an open procedure. It requires a surgical dissection to popliteal fossa and changing of the patients position during operation. As such, there is a dearth of highquality studies in the literature examining the operative management of pcl injuries and a lack of clear consensus on what the optimal method should be. Pcl reconstruction with the acufex director drill guide.
When a pcl tears, the damaged ligament tissue is often frayed and tends to scar up and shrink back, and direct primary repair is very rarely ever feasible or appropriate. Surgical reconstruction of the posterior cruciate ligament pcl is indicated in the pcldeficient knee with symptomatic instability and multiple ligamentous injury. No consensus has been reached on the optimal posterior cruciate ligament pcl reconstruction technique, including transtibial versus tibial inlay, single bundle versus double bundle, or 1 versus 2 incisions. Pcl injuries account for 20% of all knee ligamentrelated injuries. Arthroscopic outcomes are equal to open popliteus tendon reconstructions, but do not forget that the goal is a stable posterior cruciate ligament reconstruction quantitative mapping of acute and chronic pcl pathology with 3 t mri. A pcl tear is usually a result of a high velocity injury such as a vehicular accident and may be a part of multi ligament injury. Quadriceps tendon autograft for arthroscopic knee ligament. Jul 10, 2012 arthroscopic pcl reconstruction with an accessory anterolateral portal can provide a better surgical view than the conventional technique, and this can minimize the problems associated with femoral tunneling, such as inappropriate and inconsistent placement of the tunnel, abnormal angulation, and sliding of the guide tip. Chapter 41 posterior cruciate ligament reconstruction 479 midstance phase of gait. Best place for arthroscopic pcl reconstruction treatment. Accessory anterolateral portal in arthroscopic pcl reconstruction. We performed an arthroscopic transtibial reconstruction of the anterolateral bundle with a strong 11 mm. The pcl is an extremely strong ligament situated inside the knee. Posterior cruciate ligament reconstruction using a new arthroscopic tibial inlay doublebundle technique.
Arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers. I use a double bundle pcl reconstruction technique using an allograft btb graft and tibial inlay fixation. The angle of the arm does not change during the procedure. Rehabilitation guidelines for posterior cruciate ligament.
Pdf posterior cruciate ligament pcl is a major stabilizer of the knee joint. Arthroscopic singlebounded pcl reconstruction using a patellar allograft after motor vehicle accident in a 20yearold male. Pcl technical reference manual stanford university. Posterior cruciate ligament pcl reconstruction rehabilitation protocol the following is a protocol for postoperative patients following pcl reconstruction. Post operative instructions arthroscopic pcl reconstruction patella tendon bonetendonbone hamstring duel bundle graft michael e. We describe an arthroscopic pcl reconstruction technique using the quadriceps tendonpatellar bone autograft. Arthroscopic acl reconstruction by dr shekhar shrivastav. These may be isolated or occur as part of polyligament injuries. However, the choice of graft tissues continues to be controversial. Aug 31, 2016 arthroscopic meniscus repair duration. Arthroscopic inlay pcl reconstruction with pcl tightrope.
Arthroscopic pcl reconstruction with a soft tissue system. Posterior cruciate ligament pcl injuries account for nearly 20% of knee ligament injuries. Allografts in pcl reconstruction book pdf available. Now recognized as the most common knee injury in athletics, the resolution of acl rupture is being realized through arthroscopic technique. Most pcl injuries are midsubstance tears and 10%40% of. Advantages of an arthroscopic pcl reconstruction technique using this suture fixation for inlay include no posterior incision potentially adding laxity 18 and complexity 15 to the reconstruction, better visualization of the pcl footprint, and, possibly, more anatomical placement of the graft when compared with the usual open inlay. This is one of the effects of how the author can disturb the. Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries.
Pcl reconstruction is the mainstay for treatment of midsubstance tears, but primary arthroscopic pcl repair can be considered for avulsion tears. Outcome of simultaneous arthroscopic anterior cruciate. Posterior cruciate ligament pcl injuries are relatively uncommon injuries. Pdf activity level recovery after arthroscopic pcl. Toggleloc fixation device with ziploop technology arthroscopic pcl reconstruction using soft tissue graft figure 20 cut the zip sutures using the super maxcutter as close to the graft as possible figures 19 and 20.
The anatomical configuration of the posterior tibia and the square configuration of the end of commonly used drill bits require special attention. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries. Rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap, the tibiofemoral joint and the tibiofibular joint. With the possibility of pcl reconstruction with the allinside technique, there has been a surge in interest in treating pcl injuries. Arthroscopic posterior cruciate ligament reconstruction. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. Reconstruction of the pcl is a similar procedure to acl reconstruction, but the surgery is somewhat more complex and difficult, and the early rehab somewhat slower. Activity level recovery after arthroscopic pcl reconstruction. However, no study has provided a postoperative evaluation of combined posterior cruciate ligament pcl. Arthroscopic primary repair of posterior cruciate ligament. Pcl injuries can occur in isolation or, more commonly. Singlestage arthroscopic anterior and posterior cruciate. Tibial tunnel placement in posterior cruciate ligament.
The angle setting on the scale depends on the height of the working portal, this determines the drilling angle which is usually 60 by the reconstruction of the posterior cruciate ligament. Your postoperative dressing has three layers you need to understand in order to properly care for your knee for the two weeks following surgery. Pcl injuries can be treated with primary repair, which has the advantages of preserving the native tissue, maintaining proprioception, and minimal invasive surgery when compared with reconstruction surgery. Arthroscopic standard anterior and posteromedial portal. Identify the demographic characteristics of patients operated on hospital alcivar, age, gender, affiliation, causes of knee injury and laterality. Traditional bonepatellar tendonbone and hamstring tendon acl grafts are not without limitations. Arthroscopic pcl reconstruction with a novel allinside. Arthroscopic posterior cruciate ligament reconstruction using four. Arthroscopic debridement chondroplastyloose bodyforeign body removal 6 synovectomy 6 meniscectomy or meniscal repair 7 meniscal allograft transplantation 8 anterior cruciate ligament acl reconstruction 9 posterior cruciate ligament pcl reconstruction 10 medial collaterallateral collateral ligament mcllcl. Arthroscopic posterior cruciate ligament reconstruction using.
Their lysholm scores were satisfactory range, 85100. This article is intended to vrovide an overview of a procedure thatlis rapidly gaining popularity within the orthope dic community. Joints are named for the two bones that articulate with each other. In combined injuries was performed reconstruction in two stages, in a first stage acl arthroscopic repair and 4 months pcl arthroscopic reconstruction. A singleincision technique article pdf available in orthopedics 332.
Arthroscopic anatomy of the pcl robert laprade, md. However, no study has provided a postoperative evaluation of combined posterior cruciate ligament pcl and posterolateral corner plc injuries using the lgdt test. The results of this surgery are not as reproducible as in the lca and may be a slight residual instability that has no clinical impact. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards. Featuring noyes allinside and tibial inlay techniques. Arthroscopic primary posterior cruciate ligament repair with. Request pdf open tibial inlay versus arthroscopic transtibial posterior cruciate ligament reconstructions the optimal method of posterior cruciate ligament pcl reconstruction is not known. Posterior cruciate ligament pcl injury can present either as an isolated tear or in the setting. To present our surgical technique for pcl arthroscopic reconstruction in alcivar hospital. Arthrex provides a comprehensive line of pcl reconstruction instrumentation options for a variety of pcl reconstruction techniques. Arthroscopic primary posterior cruciate ligament repair. Posterior cruciate ligament pcl reconstruction indicates in grade 3 pcl rupture, avulsion fracture of pcl, combined ligamentous damage. The tibial tubercle portion of the allograft is fashioned into a 12mm to mm. All inside transtibial arthroscopic posterior cruciate.
Once drilling is completed, use a curved rasp to smooth. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving preinjury level of activity. The reconstruction of posterior cruciate ligament is being performed in an increasing number of cases due to allografts being larger and thicker than autografts. Arthroscopic primary repair of posterior cruciate ligament injuries. Lateral and medial joint opening to varus and valgus stress are documented and measured with the calibrated nerve hook to exclude associated medial or lateral. Accurate tibial tunnel placement is crucial for successful pcl reconstruction using arthroscopic tibial tunnel techniques. Oct 18, 2016 pcl reconstruction with peroneus longus aprof. The newest anatomic pcl retroconstruction guide reduces the challenge of pcl footprint targeting while simultaneously acting as a backstop to protect the neurovascular bundles. The arthroscopic lateral gutter drivethrough lgdt sign is reported to diagnose popliteus tendon pt injury with high sensitivity and speci. Posterior cruciate ligament pcl reconstructions are challenging surgeries. Allinside posterior cruciate ligament reconstruction arthroscopy.
Current concepts and controversies brian forsythe, md department of orthopaedic surgery rush university medical center midwest orthopaedics at rush chicago, il usa hot topics in pcl reconstruction 1. Featuring noyes allinside and tibial inlay techniques with a. Pcl reconstruction, a transpatellar central portal and posteromedial portal may be necessary. Arthroscopic anterior cruciate ligament reconstruction. Arthroscopic primary repair of posterior cruciate ligament injuries gregory s. Isolated posterior cruciate ligament pcl injuries are relatively rare and pcl injuries most commonly occur in the setting of multiligamentous knee injuries. Neurovascular injury is a potential complication during arthroscopic assisted or open posterior cruciate ligament pcl reconstruction. T he importance of the posterior cruciate ligament. Reconstruction of the posterior cruciate ligament pcl yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. One of the most challenging arthroscopic surgical procedures is posterior cruciate ligament pcl reconstruction. Apr 16, 2018 posterior cruciate ligament pcl injuries are relatively uncommon injuries. Arthroscopic posterior cruciate ligament reconstruction with. A standard arthroscopic exam of the knee joint is performed, and the pcl rupture is confirmed. Alternatively, use a lateral post without a leg holder.
Pcl reconstructionarthroscopichamstring graftinterference screwsday surgery. Cigna medical coverage policies musculoskeletal knee. It provides stability against posteriorly directed forces on the knee. Staged arthroscopic reconstructive surgery for multiple. Arthroscopic standard anterior and posteromedial portal posterior cruciate ligament reconstruction with remnant preservation.568 1470 424 1188 1118 212 231 129 1264 1455 1474 490 1403 1389 246 1183 131 1287 1535 1516 638 1316 796 1116 307 1131 756 213 1178 418 1421 441 1187 717 421 979 330 1268 815 386