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. 2023 Jan 6;18(1):16.
doi: 10.1186/s13018-022-03495-6.

Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

Sergio Rocha Piedade  1 , Gerson Muraro Laurito  1 , Filippo Migliorini  2 , Nicola Maffulli  3   4   5
Affiliations

Posterior cruciate ligament reconstruction using PCL inlay technique with the patient supine in bicruciate ligament injury reconstruction

Sergio Rocha Piedade et al. J Orthop Surg Res. .

Abstract

Background: Surgical reconstruction of the posterior cruciate ligament (PCL) can be technically challenging given the proximity of the popliteal artery to the PCL tibial insertion. This "no-safe zone" makes some knee surgeons less confident and willing to perform this surgical procedure.

Surgical technique: We present a PCL tibial inlay reconstruction technique using a set of instruments involving three tools (a slot cut, a bone plug positioner, and an impactor).

Conclusion: This set of instruments allows a more reproducible posteromedial approach and to produce a PCL tibial slot in a posterior cruciate ligament inlay reconstruction with the patient supine in bicruciate ligament injury reconstruction.

Keywords: Posterior cruciate ligament injuries; Posterior cruciate ligament reconstruction; Surgical instruments; Surgical procedures, operative.

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Conflict of interest statement

Prof. Nicola Maffulli is Editor in Chief of the Journal of Orthopaedic Surgery and Research.

Figures

Fig. 1
Fig. 1
Posteromedial approach with the patient prone: A the bone block of the bone-patellar tendon-bone graft (blue cyan arrow); B after fixation of the bone block at the insertion of the PCL on the tibia (white arrow)
Fig. 2
Fig. 2
Lateral (A) and front (B) views of the Piedade tibial Inlay set of instruments: slot cut (osteotome), (2) positioner, and (3) impactor
Fig. 3
Fig. 3
Femoral tunnel positioning of PCL (A) and (B) ACL (B) tunnels, and (C) ACL tibial tunnel under arthroscopic control
Fig. 4
Fig. 4
Knee posteromedial approach: Lower limb positioning with external hip rotation, and the knee flexion (A) and intraoperative view of posteromedial approach of PCL tibial insertion in the right knee (B)
Fig. 5
Fig. 5
A case of bicruciate ligament reconstruction showing the posteromedial approach (A–D) and the Piedade PCL tibial INLAY bone slot cut is positioned on the PCL tibial insertion (E)
Fig. 6
Fig. 6
Producing the PCL tibial slot using the set of instruments: slot cut (A and B) and impactor (C and D) to control the depth of the slot according to the graft bone block. Note that the lower leg is externally rotated during this phase of the procedure
Fig. 7
Fig. 7
Intraoperative radiographic view of osteotome (A) and impactor (B) positioning on the PCL tibial bed and PCL and ACL graft fixation on the tibial side (C)
Fig. 8
Fig. 8
A Illustrates the 2.5 mm tunnel just below the PCL bone slot from the posterior to the anterior aspect of the knee joint, and B shows the passage of PCL graft controlled by Ethibond 5.0 thread in the transtibial and PCL femoral tunnels
Fig. 9
Fig. 9
The PCL graft is shuttled into the knee joint through the tunnels using an Ethibond 5.0: A–E showing intraoperative views of the free end of PCL graft (yellow arrow), bone block with 3.5-mm cortical screw and washer of PCL graft (blue cyan arrow) and four stand of hamstring tendon of ACL graft (white arrow)
Fig. 10
Fig. 10
A PCL graft tensioning, impaction and fixation with a 3.5 mm cortical screw (24 or 26 mmm long) (B, C and D)
Fig. 11
Fig. 11
Drawing of bicruciate reconstruction after PCL and ACL fixation
See this image and copyright information in PMC

References

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