Arthroscopic Transtibial Tunnel Posterior Cruciate Ligament Reconstruction

Abstract

The goals leading to successful posterior cruciate ligament (PCL) reconstruction surgery include identification and treatment of associated pathology such as posterolateral instability, posteromedial instability, and lower extremity malalignment. The use of strong graft material, properly placed tunnels to as closely as possible approximate the posterior cruciate ligament insertion sites, and the minimization of graft bending also enhance the probability of the PCL reconstruction success. In addition, mechanical graft tensioning, primary and backup PCL graft fixation, and the appropriate postoperative rehabilitation program are also necessary ingredients for PCL reconstruction success. Both single- and double-bundle PCL reconstruction surgical techniques are successful when evaluated with stress radiography, KT-1000 arthrometer measurements, and knee ligament rating scales. Indications for double-bundle PCL reconstruction as of this writing include severe hyperextension of the knee and revision PCL reconstruction. About 2–18-year postsurgical results in combined PCL, ACL, and medial- and lateral-side knee injuries (global laxity) revealed very successful PCL reconstruction using the arthroscopic transtibial tunnel surgical technique. The purpose of this chapter is to describe the arthroscopic transtibial tunnel PCL reconstruction surgical technique and present results with this surgical procedure.