LaPrade Robert F, Pierce Casey M
The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657. E-mail address for R.F. LaPrade:
JBJS Essent Surg Tech. 2012 Jan 11;2(1):e1. doi: 10.2106/JBJS.ST.K.00025. eCollection 2012 Feb.
As the varied results seen after posterior cruciate ligament (PCL) reconstructions might be due to surgical techniques that fail to reconstruct both functional bundles of the PCL and that injure the vastus medialis obliquus muscle, we developed a technique to address these problems and thus improve patient outcomes.
STEP 1 EXAMINE UNDER ANESTHESIA: Assess range of motion and patellofemoral stability; perform stress tests, Lachman and pseudo-Lachman tests, pivot shift test, drawer tests, reverse pivot shift test, and dial test.
STEP 2 PERFORM ARTHROSCOPY: Preserve any remnants of PCL at anterolateral and posteromedial bundle attachment sites to promote vascular healing.
STEP 3 DRILL TIBIAL GUIDEPIN: Guidepin enters tibia at, roughly, 45° angle and 6 cm distal to joint line, midway between anterior tibial crest and posteromedial tibial border.
STEP 4 PREPARE GRAFTS: Use Achilles tendon allograft for anterolateral bundle and semitendinosus or tibialis anterior allograft for posteromedial bundle.
STEP 5 DRILL TUNNELS: Guidepin position should be slightly lateral to midline between apices of medial and lateral tibial eminences on anteroposterior radiograph and approximately 7 mm proximal to "champagne-glass drop-off" on lateral radiograph.
STEP 6 PLACE AND SECURE GRAFTS IN FEMUR AND TIBIA: Tug hard on grafts through anterolateral arthroscopic portal to verify that they are secured within the femoral tunnel.
STEP 7 POSTOPERATIVE CARE: Manage knee motion for first six weeks by prone knee flexion to counteract deleterious effects of gravity on reconstruction.
In a cohort of thirty-nine total patients, thirty-three males and six females, with an average age of thirty-three years, seven isolated PCL reconstructions and thirty-two combined knee reconstructions were performed.
IndicationsContraindicationsPitfalls & Challenges.
后交叉韧带（PCL）重建术后出现的各种不同结果，可能是由于手术技术未能重建PCL的两个功能束且损伤了股内侧斜肌所致。因此，我们开发了一种技术来解决这些问题，从而改善患者的治疗效果。
步骤1 麻醉下检查：评估活动范围和髌股稳定性；进行应力试验、Lachman试验和伪Lachman试验、轴移试验、抽屉试验、反向轴移试验和旋转试验。
步骤2 进行关节镜检查：保留PCL在前外侧和后内侧束附着部位的任何残余部分，以促进血管愈合。
步骤3 钻胫骨导针：导针以大约45°角进入胫骨，位于关节线远端6 cm处，胫骨前缘与胫骨后内侧缘之间的中点。
步骤4 准备移植物：前外侧束使用跟腱同种异体移植物，后内侧束使用半腱肌或胫骨前肌同种异体移植物。
步骤5 钻隧道：在前后位X线片上，导针位置应略偏向胫骨内外侧髁顶点连线的中线外侧，在侧位X线片上应位于“香槟酒杯状凹陷”近端约7 mm处。
步骤6 将移植物放置并固定于股骨和胫骨：通过前外侧关节镜入口用力牵拉移植物，以确认其固定在股骨隧道内。
步骤七 术后护理：在前六周通过俯卧位屈膝来管理膝关节活动，以抵消重力对重建的有害影响。
在总共39例患者中，男性33例，女性6例，平均年龄33岁，进行了7例单纯PCL重建和32例膝关节联合重建。
适应证、禁忌证、陷阱与挑战。
