Arthroscopic Transtibial PCL Reconstruction: Surgical Technique and Clinical Outcomes

Shin, Jessica; Maak, Travis G.

doi:10.1007/s12178-018-9489-9

Cited by 4 publications

(4 citation statements)

References 47 publications

(31 reference statements)

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“…Tibial graft fixation during anatomic SB and DB PCL-R can be performed using the transtibial or the tibial inlay technique by an all-arthroscopic, arthroscopic assisted, or an open approach [ 8 , 42 , 62 , 76 ]. Positioning of a PCL drill guide medial to the tibial tubercle just proximal to the pes anserinus, aiming for a sagittal angle of 45°, allows subsequent insertion of a guidewire to reach the anatomic tibial PCL insertion zone when performing the transtibial technique (a more detailed description of radiographic landmarks for the native femoral and tibial insertion zones of the PCL is given in Part 1 of the evidence-based update on the management of primary and recurrent PCL injuries) [ 18 , 74 ]. A frequently reported drawback of the transtibial technique is the formation of an acute angle by the PCL graft exiting the tibial tunnel, also known as the “killer turn” [ 53 ].…”

Section: Technical Aspects In Pcl-rmentioning

confidence: 99%

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Winkler

Zsidai

Wagala

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Isolated and combined posterior cruciate ligament (PCL) injuries are associated with severe limitations in daily, professional, and sports activities as well as with devastating long-term effects for the knee joint. As the number of primary and recurrent PCL injuries increases, so does the body of literature, with high-quality evidence evolving in recent years. However, the debate about the ideal treatment approach such as; operative vs. non-operative; single-bundle vs. double-bundle reconstruction; transtibial vs. tibial inlay technique, continues. Ultimately, the goal in the treatment of PCL injuries is restoring native knee kinematics and preventing residual posterior and combined rotatory knee laxity through an individualized approach. Certain demographic, anatomical, and surgical risk factors for failures in operative treatment have been identified. Failures after PCL reconstruction are increasing, confronting the treating surgeon with challenges including the need for revision PCL reconstruction. Part 2 of the evidence-based update on the management of primary and recurrent PCL injuries will summarize the outcomes of operative and non-operative treatment including indications, surgical techniques, complications, and risk factors for recurrent PCL deficiency. This paper aims to support surgeons in decision-making for the treatment of PCL injuries by systematically evaluating underlying risk factors, thus preventing postoperative complications and recurrent knee laxity. Level of evidence V.

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Section: Technical Aspects In Pcl-rmentioning

confidence: 99%

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Winkler

Zsidai

Wagala

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Prior to this, the senior author’s PCL technique utilized a single bundle with Achilles tendon allograft with a trans-tibial technique, with interference screw fixation on the femur and interference screw plus screw and washer fixation on the tibia. 23 , 24 The senior author’s repair prior to internal brace consisted of a suture repair for proximal injuries of the PCL without a spanning internal brace.…”

Section: Methodsmentioning

confidence: 99%

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Fathi,

Thompson,

Bolia

et al. 2024

ORR

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Purpose To compare the patient-reported outcomes between patients with posterior cruciate ligament (PCL) reconstruction or repair alone versus PCL reconstruction or repair with internal bracing (IB) in the context of multi-ligament knee injuries (MLKI). Methods All patients who underwent surgical management of MLKI at two institutions between 2006 and 2020 were retrospectively identified and offered participation in the study. Patient reported outcomes were measured via three instruments: Lysholm Knee score, Multiligament Quality of Life (ML-QOL), and the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT). The postoperative outcomes and reoperation rates were compared between the internal bracing and non-internal bracing groups. Results Fifty-two patients were analyzed; 34 were included in the IB group (17.6% female; age 33.1 ±1.60 years), and 18 were included in the non-IB group (11.1% female; age 34.1 ±3.72 years). Mean follow-up time of the entire cohort was 1.44 ± 0.22 years (IB: 1.21 ± 0.18; non-IB: 2.1 ±0.65). There were no significant differences between PROMIS CAT [PROMIS Pain (54.4 ±1.78 vs 51.7 ±1.70, p=0.319), Physical Function (44.3 ±2.27 vs 47.9 ±1.52, p=0.294), Mobility (44.0 ±1.71 vs 46.1 ±2.10, p=0.463)], ML-QOL [ML-QOL Physical Impairment (40.7 ±4.21 vs 41.7±5.10, p=0.884), Emotional Impairment (49.2 ±4.88 vs 44.7±5.87, p=0.579), Activity Limitation (43.5 ±4.56 vs 31.5±3.62, p=0.087), Societal Involvement (44.9 ±4.96 vs 37.5 ±5.30, p=0.345)] and Lysholm knee score (61.8 ±4.55 vs 61.0 ±4.95, p=0.916) postoperatively compared to the non-IB group. Conclusion In this group of patients, function and patient-reported outcomes between patients treated with PCL reconstruction and repair without internal brace versus those with additional internal brace augmentation were not significantly different. Further research encompassing a larger patient sample is necessary to investigate the efficacy of the internal brace for PCL injury in the context of MLKI injuries.

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“…They suggested knee flexion to 90 degrees as a mandatory position during the PM portal creation. 15 The injury to the saphenous nerve and vein was documented by multiple studies but the occurrence is uncommon. 15,16 PCL avulsion fracture may be fixed with 4 mm cancellous using two PM portals [15][16][17] placed in the safe zone with consideration of the capsular folds for PCL tibial avulsion fixation with screw.…”

Section: Introductionmentioning

confidence: 99%

“…15 The injury to the saphenous nerve and vein was documented by multiple studies but the occurrence is uncommon. 15,16 PCL avulsion fracture may be fixed with 4 mm cancellous using two PM portals [15][16][17] placed in the safe zone with consideration of the capsular folds for PCL tibial avulsion fixation with screw. Fixation method of PCL avulsion fracture is usually dictated by the size of the fragment.…”

Section: Introductionmentioning

confidence: 99%

The Outcomes of Posterior Cruciate Ligament Tibial Avulsion Fixation With a Screw Using a Dual Posteromedial Portal Technique

Vishwakarma

Gali²,

Filho³

et al. 2022

Acta ortop. bras.

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Objectives Our purpose was to evaluate the clinical results of PCL tibial avulsion fracture fixation performed with 4 mm cancellous screws using a dual posteromedial (PM) portal technique. Methods In a prospective study, we followed 12 patients submitted to PCL tibial insertion avulsion arthroscopic fixation using dual PM portals with cancellous screws from March 2014 to Jan 2020. The proximal higher PM portal served as an instrument portal and provided an optimal trajectory for arthroscopic screw fixation of larger PCL avulsion fractures. The lower PM portal was used as a viewing portal. Results Significant improvements were found between the preoperative and postoperative mean Lysholm scores at six months. The preoperative IKDC score mean of 10.13 increased to 89.3 at the end of six months. Minor adverse results with this technique were: grade I on posterior sag in five knees (41.6%), temporary stiffness in two cases (16.7 %), delayed union in one patient (8.3 %), and difficulty squatting at the end of six months in one patient (8.3%). Temporary extension lag was present in two individuals (16.7%), and fixed subtle flexion deficit of 3-5 degrees occurred in one individual (8.3 %). Conclusion The outcomes obtained with the proposed technique were similar to those obtained with open techniques, although mild flexion deficits and discreet posterior sag may be present in a significant number of cases. Level of Evidence II; Prospective Cohort Study.

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Arthroscopic Transtibial PCL Reconstruction: Surgical Technique and Clinical Outcomes

Cited by 4 publications

References 47 publications

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

The Outcomes of Posterior Cruciate Ligament Tibial Avulsion Fixation With a Screw Using a Dual Posteromedial Portal Technique

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