[Arthroscopic reconstruction of the anterolateral bundle of the posterior cruciate ligament in single-bundle technique with autologous hamstring grafts].

OBJECTIVE

Restoration of the function of the posterior cruciate ligament (PCL).

INDICATIONS

Chronic posterior instability with posterior tibial translation of >10 mm.

CONTRAINDICATIONS

Fixed posterior drawer, local infections at the knee joint, local soft-tissue damage, poor compliance of the patient.

SURGICAL TECHNIQUE

Surgery starts with arthroscopic examination of the knee joint and therapy of associated injuries (meniscus and cartilage injuries). Harvesting of the semitendinosus and gracilis tendons is performed via a 3 cm long skin incision 1 cm distally and medially of the tibial tuberosity. The tendons are folded to a four- or five-stranded graft with a minimum length of 10 cm. The femoral tunnel for the graft is drilled via a deep anterolateral portal under arthroscopic control. For drilling of the tibial tunnel, a posteromedial portal is needed. The tibial insertion of the PCL is debrided with a shaver and a specific raspatory. For tibial tunnel placement, a specific closed aimer is used and a Kirschner wire is placed in the center of the tibial insertion. This Kirschner wire is overdrilled using a cannulated drill with a diameter according to the graft size. After femoral fixation, the graft is tensioned in 90° flexion with 80 N. At the femoral and tibial side, a hybrid fixation is performed with a button (flipp tack) and a resorbable interference screw. If there are any signs of posterolateral instability, a posterolateral corner reconstruction is performed before tensioning and fixation of the PCL graft.

POSTOPERATIVE MANAGEMENT

For 6 weeks, the knee is immobilized in extension with a posterior tibial support (PTS) brace (Medi, Bayreuth, Germany). Passive range of motion exercises should be performed in prone position (first 2 weeks 0-0-30°, 3rd to 4th week 0-0-60°, 5th to 6th week 0-0-90°). After the first 6 weeks, a movable brace is needed at daytime. At nighttime, the patient has to wear the PTS brace.

RESULTS

Between 2003 and 2006, a PCL reconstruction in singlebundle technique was performed in 58 patients. In 42 cases, a simultaneous reconstruction of the posterolateral corner was done. The Lysholm Score improved from 62.2 to 88.4 points, the Tegner Activity Score from 3.3 to 5.4 points.