Posterior Cruciate Ligament Reconstruction

To achieve successful PCL reconstruction, we should know the correct surgical technique, especially the femoral tunnel position, and also as much as possible to preserve the remnant of the PCL. The tunnel position on the femoral side is more important than on the tibial side. The guide pin is inserted through the small-diameter hole 5–6 mm proximal to the edge of the articular cartilage of the medial femoral condyle. To obtain the longer tunnel length, use an oval or rounded rectangular shape dilator to better cover the anatomical PCL femoral and tibial attachment site. Preserve PCL remnant as much as possible, as this will work as a soft bumper cushion effect, and also, remnant lax PCL will shrink and heal with a new reconstructed graft. The edge of the tunnel opening should be chamfered with a rasp to reduce the killer turn effect of both tunnels. The tibial tunnel was created using a modified transseptal portal—the posteromedial portal was created using a standard arthroscopic technique. A Wissinger rod was inserted through the posteromedial portal to the posterolateral side of the knee, along just posterior to the PCL fiber to avoid neurovascular damage. (Using a modified transseptal technique). Using the PCL tibial angle guide (55–60° to make the tibial tunnel as oblique as possible, just distal to the center of the PCL tibial attachment fiber), insert through the anteromedial portal to the posterior compartment. Reaming with a 5 mm cannulated reamer along the guide pin and then using a rounded rectangular dilator 12 × 4mm, 13 × 5mm, 13 × 6mm, 14 × mm, depending on graft size, gradually increase. A wire loop and a No. 5 Ethibond suture loop were passed through the lower AMP to the femoral tunnel and tibial tunnel separately for passing the graft at each end. The graft was fixed after cyclic loading with an adjustable loop cortical suspension device (Tight Rope RT, Arthrex or Ultra-Button Inc., USA) and two transverse cross pins (Rigid Fix, DePuy Synthes Mitek Sports Medicine, USA) on the femoral side and a biodegradable interference screw as an IntraFix technique with an additional post-tie screw on the tibial side. I would like to do a backup fixation of the femur and the tibia on both sides. The surgeon should carefully evaluate and treat the combined injury, especially the posterolateral rotatory instability (PLRI) and also the posteromedial instability. Quadriceps strengthening is important, starting preoperatively. Postoperative rehabilitation should be more gradual to achieve further knee flexion. The patient should be made aware of the importance of rehabilitation (gradual, gentle, passive flexion of the knee) and the importance of exercises to strengthen the quadriceps muscle. Active flexion of the knee should be performed at least 3–4 months after surgery, and flexion should be performed carefully so that the proximal part of the tibia does not have a posterior sagging force.