Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation
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ABSTRACT:
SUBMITTER: Zhao J
PROVIDER: S-EPMC8556646 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Double-bundle posterior cruciate ligament (PCL) reconstruction has long been attempted to obtain better clinical results than single-bundle PCL reconstruction. In most previous reports regarding double-bundle PCL reconstruction, one tibial tunnel and various kinds of grafts were used. We introduce a two-tibial tunnel, double-bundle PCL reconstruction technique with ultra-strong grafts. The critical points of this technique are proper creation of the tibial tunnels and the protection of the posterior neurovascular structures. Our clinical experience indicates this technique can lead to satisfactory stable outcomes. We believe that this technique will provide a reasonable choice for PCL reconstruction without remnant preservation.
| S-EPMC8416969 | biostudies-literature
Project description:The clinical results of posterior cruciate ligament reconstruction (PCL) still leave much room for improvement. To get better knee stability, the double-bundle reconstruction, the use of strong grafts, and the preservation of the remnant have been applied. However, the combination of the 3 measures has seldom been reported. Thus I introduce a 4-tunnel double-bundle PCL reconstruction technique, in which I combine the use of strong grafts and preservation of the remnant. The critical point of this technique is manipulating skillfully across the femoral notch with the preservation, as well as the hindrance to operation of the PCL remnant. My clinical experience indicates this technique is somewhat complicated but most effective. I believe the introduction of this technique will provide an additional choice when PCL reconstruction is to be performed.
| S-EPMC8556672 | biostudies-literature
Project description:Anatomical anterior cruciate ligament (ACL) reconstruction is a reasonable transition from isometric ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through the medial portal technique. However, in our clinical practice, we found that anatomical ACL reconstruction can be performed easily and accurately by creating a tibial tunnel, which is accomplished by setting the tibial tunnel with correct angulation to the sagittal plane and tibial axis. Hence, we introduce this special transtibial anatomical ACL reconstruction technique, in which the most critical step is the creation of a shallow tibial tunnel with a proximal projection to the anatomical location of the femoral tunnel. This technique is indicated for primary ACL reconstructions in skeletally mature patients. We believe this Technical Note will give a special view on anatomical ACL reconstruction.
| S-EPMC7528436 | biostudies-literature
Project description:This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant.
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Project description:We describe the all-anterior approach for arthroscopic posterior cruciate ligament (PCL) reconstruction with remnant preservation. In this technique, PCL is reconstructed through 3 anterior portals: anterolateral portal, anteromedial portal, and inferior anterolateral portal, whereas the PCL remnant is preserved with great possibility. With the PCL elevator and wire catcher (Smith & Nephew), a self-made wire loop is introduced into the joint through the tibial tunnel, and is used to pass the graft in an all-inside-out fashion. In the transtibial PCL reconstruction technique, posterior portals are routinely adopted and the PCL remnant is often removed for good vision and adequate operative space, which can prolong surgery time and increase the potential risk of iatrogenic injury. In comparison, this technique not only simplifies the surgical procedure and reduces surgical trauma, but also preserves the remnant for our patients.
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Project description:We describe a surgical technique for arthroscopic posterior cruciate ligament (PCL) reconstruction with remnant preservation of the original PCL fibers using a posterior trans-septal portal approach. Using the transtibial technique and the posterior trans-septal portal approach allows good visualization of the tibial tunnel preparation, easy access to the tibial tunnel without neurovascular injury, and preservation of remnant PCL fibers. In the preparation of the tibial tunnel, we expose the PCL tibial attachment site completely, detach the posterior capsule from the PCL, and preserve the distal stump of the PCL without neurovascular injury. PCL reconstruction is performed in a way that preserves the remnant PCL fibers. We report on our surgical technique for arthroscopic PCL reconstruction preserving the original PCL fibers.
| S-EPMC5709718 | biostudies-literature
Project description:In anterior cruciate ligament (ACL) reconstruction, fixation of the graft with hardware is a routine procedure. However, in some cases when the hardware is not intended to be used or is unavailable, ACL reconstruction with hardware-free fixation must be the treatment of choice. We introduce a single-bundle anatomical hardware-free ACL reconstruction technique in which a set of Y-shaped femoral tunnels is created for the fixation of the proximal end of the graft over the bone bridge between the 2 outer orifices, and a transtibial ridge tunnel is created to set a suture loop with a knot for the fixation of the distal end of the graft at the suture loop. We believe the introduction of this technique will provide a reasonable option for single-bundle anatomical ACL reconstruction.
| S-EPMC8252817 | biostudies-literature
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
Project description:The procedure for repairing the posterior cruciate ligament (PCL) has a steep learning curve and entails numerous difficult steps during surgery, because of the proximity of the neurovascular bundle, difficult passage of the graft through the posterior capsule, and risk of poor tibial fixation because of the long intramedullary trajectory of the graft. The use of instruments for retrograde reaming and a new device for adjustable cortical suspensory fixation allows for a safe, reproducible all-inside double-bundle PCL reconstruction by simplifying these difficult steps. We used anterior tibial allograft or hamstring autograft together with adjustable suspensory fixation devices that allow tensioning (after fixation) of the posterolateral bundle in extension and the anteromedial bundle in flexion.
| S-EPMC3678623 | biostudies-literature
Project description:Posterior cruciate ligament (PCL) reconstruction with preservation of the remnant PCL fibers has been performed under the assumption that preserving the fibers contributes to knee kinematics, grafted tendon healing, and recovery of proprioception. This technical note presents a single-bundle, transtibial PCL reconstruction with anatomic graft passage between the remnant PCL fibers. The operation is performed using the posterior trans-septal portal, which can provide excellent visualization while preserving a large amount of remnant PCL fibers. In addition, this technique allows for anatomic graft passage without soft-tissue impingement, and it minimizes the risk of nonanatomic positioning of the PCL grafts.
| S-EPMC4246403 | biostudies-literature