Posterior cruciate ligament reconstruction using aseptum-preserving technique.

Abstract

Description of areproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on aseptum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure. Acomplete gradeIII symptomatic tear of the PCL associated with instability and often discomfort (deceleration, stairs) or subsequent gonalgia arising from the medial compartment or patellofemoral joint. Injury of the peripheral joint stabilizers alongside the PCL including the posterolateral corner or acomplete medial knee injury. The procedure is indicated in chronic cases, but also in acute cases of posterior instability > 10 mm, if it is an intraligamentous tear with dislocated PCL stumps. Bony avulsions of the PCL suitable for refixation, soft tissue compromise, infection, advanced osteoarthritic disease. After diagnostic arthroscopy of the knee, the ipsilateral semitendinosus and gracilis tendons are harvested and prepared as a6-strand graft for PCL reconstruction. One high anterolateral viewing portal, one low anterolateral portal, one anteromedial portal, and aposteromedial portal are used for single-bundle reconstruction via one femoral and one tibial bone tunnel and hybrid graft fixation. Weight bearing is restricted to 20 kg for 6weeks. PCL brace with tibial support for aperiod of 12weeks. Flexion is limited to 30° in the first 2 postoperative weeks, then 60° for 2weeks, and 90° for 2 further weeks. Passive flexion in prone position is performed. Active focused muscle strengthening exercise is begun after 6weeks postoperatively and participation in competitive sports is not recommended before full muscle strength and coordination is re-established, at the earliest 9-12months postoperatively. Two isolated and 19 combined PCL injuries were treated. Mean patient age was 27.4 years, and the minimal follow-up was 12months. On average, we found good clinical outcome with slight degree of posterior laxity (4.1 mm) after PCL reconstruction in comparison with the contralateral knee. No patient showed signs of effusion at follow-up. Range of motion was fully restored in 19 of 21patients. One patient suffered failure due to persistent posterior instability and persistence of symptoms.