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. 2024 Jan 12;4(1):26350254231184905.
doi: 10.1177/26350254231184905. eCollection 2024 Jan-Feb.

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Mark A Glover  1 , Thomas W Mason  1 , Benjamin S Albertson  2 , Nicholas A Trasolini  2 , Brian R Waterman  2
Affiliations

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Mark A Glover et al. Video J Sports Med. .

Abstract

Background: Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal.

Indications: PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes.

Technique description: A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises.

Results: At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol.

Discussion/conclusion: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Keywords: PCL reconstruction; athlete; meniscal ramp repair; quadriceps tendon autograft.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: N.A.T. has received support for education from Arthrex., Smith + Nephew, Southtech Orthopedics and Medwest Associates; honoraria and travel expenses from Encore Medical; a grant from Arthrex and Medical Device Business Services; and travel expenses from Stryker Corporation. B.R.W. has received travel expenses and speaking fees from Arthrex and Vericel Corporation; consulting fees from DePuy Synthes, Vericel Corporation, FH Orthopedics, and Medical Device Business Services; honoraria from Musculoskeletal Transplant Foundation and Vericel Corporation; support for education from Peerless Surgical, Southtech Orthopedics, and Arthrex; and travel expenses from Piedmont Plus Innovation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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