Full arthroscopic inlay reconstruction of posterior cruciate ligament

Abstract

We report a full arthroscopic inlay reconstruction technique to avoid the morbidity of traditional open inlay procedure. With the transeptal approach a trough is created arthroscopically at the anatomical tibial insertion of the PCL, which must fit with the patellar bone block of a quadriceps tendon autograft. The bone plug is harvested with two nonabsorbable sutures, each end of which is passed through two holes from the cortical to the cancellous side. The graft is introduced into the knee joint from the posteromedial portal using two traction sutures passed previously through two transtibial tunnels exiting at the middle of the trough. Tibial graft fixation is achieved using the sutures knotted at the anterior aspect of the tibial cortex. Arthroscopic inlay procedure may be a rational surgical alternative because it reduces the crucial steps of an open inlay procedure, such as extensive exposure of the posterior capsule, the need of position change with risk of contamination, longer surgical time, and the risk of bone block fracture if an autograft is harvested. The arthroscopic procedure may also be performed also when hardware presence of previous surgery limits use of the open technique. We initially limited use of this technique to patients: (1) undergoing PCL revision surgery, (2) having hardware from previous tibial surgery, and (3) presenting a PCL lesion following posterior dislocation with previous vascular surgery. The results have been good, and we are now also using this technique for primary PCL reconstruction with favorable results.