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All-Inside Posterior Cruciate Ligament Reconstruction With a GraftLink.

ABSTRACT: Posterior cruciate ligament (PCL) reconstructions are challenging surgeries. Recent advances have included double-bundle PCL, arthroscopic inlay, and all-inside techniques. This technical note presents an anatomic, single-bundle, all-inside PCL reconstruction with an anterior tibialis allograft GraftLink construct. The surgery was performed with FlipCutter guide pins and ACL TightRope RT. The case involved a 22-year-old woman with an isolated grade 3 PCL tear that had failed nonoperative treatment. The technique described is minimally invasive.

SUBMITTER: Adler GG

PROVIDER: S-EPMC3716209 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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All-Inside Posterior Cruciate Ligament Reconstruction With a GraftLink.

Adler Gerard G GG

Arthroscopy techniques 20130329 2

Posterior cruciate ligament (PCL) reconstructions are challenging surgeries. Recent advances have included double-bundle PCL, arthroscopic inlay, and all-inside techniques. This technical note presents an anatomic, single-bundle, all-inside PCL reconstruction with an anterior tibialis allograft GraftLink construct. The surgery was performed with FlipCutter guide pins and ACL TightRope RT. The case involved a 22-year-old woman with an isolated grade 3 PCL tear that had failed nonoperative treatme ...[more]

PMID: 23875134

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All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

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Project description:One of the most challenging arthroscopic surgical procedures is posterior cruciate ligament (PCL) reconstruction. PCL injuries account for 20% of all knee ligament-related injuries. These may be isolated or occur as part of poly-ligament injuries. With the possibility of PCL reconstruction with the all-inside technique, there has been a surge in interest in treating PCL injuries. With the PCL being one of the strongest ligaments in the body and a primary restraint to posterior translation of the tibia, the need for PCL reconstruction is being more and more recognized. Surgeons often find it difficult to negotiate the so-called killer turn while attempting arthroscopic PCL reconstruction. We describe the use of the GraftLink graft construct through the posteromedial portal in 7 patients (6 male and 1 female patient) with isolated PCL injuries, which we believe not only allows us to perform the all-inside PCL reconstruction but also does away with the difficulty of the killer turn encountered while performing the arthroscopic PCL reconstruction.

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Nanoscopic-Assisted Anterior Cruciate Ligament-Posterior Cruciate Ligament Reconstruction.

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TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft.

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Double-Bundle, All-Inside Posterior Cruciate Ligament Reconstruction: A Technique Using 2 Separate Autologous Grafts.

Project description:In a double-bundle posterior cruciate ligament reconstruction, several surgical techniques are available. Compared with other techniques, the advantages of the all-inside technique and cortical suspension devices with variable loop length are that shorter grafts can be used, tendons can be quadrupled, and a double-bundle posterior cruciate ligament reconstruction can be performed with autologous grafts. Furthermore, the all-inside technique provides independent outside-in socket reaming and is soft tissue, cortex, and bone sparing because no full diameter tunnels but sockets are created with a small diameter guide pin, which can transform into a retrograde drill. Sockets could however lead to bottoming out of the grafts at the femoral side and subsequent residual laxity. This can be avoided by using 2 separate grafts that are fixed in 2 femoral sockets before they are independently fixed and tensioned in 1 tibial socket in their corresponding flexion angle. In this technical note, we present a double-bundle, all-inside posterior cruciate ligament reconstruction using 2 separate autologous grafts.

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Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

Project description:The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics. We detail our technique for an anatomic double-bundle PCL reconstruction using Achilles and anterior tibialis tendon allografts.

| S-EPMC4886264 | biostudies-literature

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Project description:The associated lesion of the posterior oblique ligament (POL) in the setting of anterior cruciate ligament rupture is quite frequent due to the same rotational mechanism. The diagnosis of POL lesions is challenging, and physical examination is delicate; moreover, they can be easily missed on magnetic resonance imaging. Once recognized, POL lesions must be repaired to restore posteromedial corner kinematics. The aim of this Technical Note is to present a safe and effective method for POL repair in the set of an anterior cruciate ligament reconstruction.

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Global variation in isolated posterior cruciate ligament reconstruction.

Project description:PurposeIn the setting of persistent instability or failed non-operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction.MethodsA systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America.ResultsForty-five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans-tibial drilling and outside-in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia.ConclusionSurgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single-bundle reconstruction with hamstring autograft through a trans-tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females.Level of evidenceSystematic review, Level IV.

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