Achtnich A, Schmitt A, Forkel P, Imhoff A B, Beitzel K
Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.
Oper Orthop Traumatol. 2019 Feb;31(1):12-19. doi: 10.1007/s00064-018-0578-0. Epub 2018 Nov 26.
The aim of arthroscopic bracing of the posterior cruciate ligament (PCL) is to restore anatomic and biomechanic function in acute PCL tears. Therefore, primary augmentation of the PCL by using a stable suturing system is used.
Acute tears of the PCL, femoral avulsions, isolated or combined in cases of multiligament injuries (knee dislocations of Schenk types II-IV).
Chronic instabilities of the PCL, infection of the knee joint.
Arthroscopic preparation of the femoral PCL footprint. Suturing of the PCL stump with non-resorbable sutures. Placement of the femoral and tibial tunnel with a specific arthroscopic PCL guide. Femoral fixation of the bracing system and the PCL augmenting sutures extracortical via a button or intraarticular with a suture anchor. Tibial fixation via a button has to be performed in a minimum of 80° of flexion and under permanent anterior drawer tension.
Brace in full extension with posterior support 24 h/day, range of motion (ROM) restricted up to 90° of flexion and limited weight bearing with 20 kg for the first 6 weeks postoperatively. After 6 weeks, weight bearing and ROM can be increased and a solid frame brace with posterior support is recommended for the next 6 weeks.
关节镜下后交叉韧带（PCL）支撑的目的是恢复急性PCL撕裂时的解剖和生物力学功能。因此，采用稳定的缝合系统对PCL进行一期增强。
PCL急性撕裂、股骨撕脱、多韧带损伤（申克II-IV型膝关节脱位）中的孤立或合并损伤。
PCL慢性不稳定、膝关节感染。
关节镜下准备股骨PCL足迹。用不可吸收缝线缝合PCL残端。使用特定的关节镜PCL导向器放置股骨和胫骨隧道。支撑系统和PCL增强缝线通过纽扣在股骨外皮质固定或通过缝线锚钉在关节内固定。胫骨通过纽扣固定必须在至少80°屈曲且持续前抽屉张力下进行。
术后第1个6周，全天24小时佩戴带后托的完全伸直支具，活动范围（ROM）限制在屈曲90°以内，负重限制在20kg。6周后，可增加负重和ROM，接下来6周建议佩戴带后托的坚固框架支具。
