Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency.

During a recent three-year period, 39 patients underwent surgical procedures for lesions of the posterior complex of the knee. The results in 28 followed for greater than six months (average followup, 16 months) are reported; eight are presently in the early rehabilitative phase and three have been lost to followup. In reconstruction for chronic laxity, a semitendinosus replacement of the posterior cruciate ligament with anterior advancement of the lateral arcuate complex is recommended. Use of the medial gastrocnemius tendon is still advised in selected cases. Reconstruction for posterolateral rotatory laxity with an intact posterior cruciate is performed with anterior advancement of the popliteus tendon and the arcuate complex. Pes anserinus transfer, imbrication of the posterior oblique ligament, and biceps tenodesis may be performed as supplemental procedures.