All-Arthroscopic Posterior Cruciate Ligament Distal Reattachment With Extracortical Fixation

Abstract

Avulsion fractures of the posterior cruciate ligament (PCL) are a rare, but serious, knee pathology. Early surgical treatment is regarded as necessary to maintain knee stability. Recommended management involves open reduction with internal fixation through a posterior approach. However, open surgeries are associated with a greater risk of complications. Current data suggest excellent outcomes for arthroscopic-assisted fixation, with a low complication rate. The purpose of this technical note is to present an all-arthroscopic PCL distal reattachment with extracortical fixation technique. This technique provides precise fracture reduction, is easily reproducible, and is relatively safe to treat PCL tibial avulsion fractures.

Fig 1

Arthroscopic view from anterolateral viewing portal in a right knee. Posterior cruciate ligament tibial avulsion fracture (blue arrow). (MFC, medial femoral condyle; MTP, medial tibial plateau, MM, medial meniscus.)

Fig 2

Arthroscopic view from anterolateral viewing portal in a right knee. A blunt trocar (white arrow) is used to assess for the potential of the PCL avulsion fracture reposition. The blue arrow presents avulsed fragment reduction. (MFC, medial femoral condyle; MTP, medial tibial plateau; MM, medial meniscus.)

Fig 3

Arthroscopic view from anterolateral viewing portal in a right knee, trans- notch maneuver. An additional high posteromedial portal is placed 2 cm above the posteromedial synovial fold (dashed line) using a needle and surgical blade (white arrows).

Fig 4

Arthroscopic view from anterolateral viewing portal in a right knee, transnotch maneuver. Arthroscopic canula (white arrow) is placed in the high posteromedial portal to facilitate maneuvering inside the joint.

Fig 5

Arthroscopic view from anterolateral viewing portal in the knee. An eyelet pin (white arrow) is placed in the native posterior cruciate ligament (PCL) tibial attachment (blue arrow) and used to drill the tibial tunnel running from the posteromedial to anterolateral part of the tibia.

Fig 6

Arthroscopic view from anterolateral viewing portal in a right knee. The FiberTape (white arrow, A) suspended on the Surgical Plate (yellow arrow, B) is introduced through the previously prepared tibial tunnel for final reposition of the posterior cruciate ligament tibial avulsion fracture (blue arrow, C). (MFC, medial femoral condyle; MTP, medial tibial plateau; MM, medial meniscus.)