Revision of Failed-Posterior Cruciate Ligament (PCL) Reconstruction Due To Tibial Tunnel Misplacement: A Case Report

OBJECTIVES: Posterior cruciate ligament (PCL) reconstruction failure is a rare condition found. The failure caused by some factors, including improper graft tunnel placement. The proper tibial tunnel placement in PCL reconstruction is still controversial. To have an anatomical tunnel is essential to decrease the risk of failure. The use of PCL jig only to guide the direction of the tibial tunnel may not always give good results. CASE PRESENTATION: We report a case of a 29-year-old male with a total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with a transseptal portal technique to ensure the tibial tunnel is placed inappropriate position. RESULT: The cause of failure was associated with the miss position of the tibial tunnel. The tibial tunnel performed in previous surgery was too anterior than the anatomical footprint. This condition might be caused by a surgical technique that depending only on PCL jig to guide the tibial tunnel direction and location. We performed a transseptal portal technique to get better visualization on the posterior aspect of the knee to achieve the proper direction of the tibial tunnel. CONCLUSION: The use of PCL jig as the only tool for guiding tibial tunneling should be avoided. An additional tool such as a transseptal portal is required to ensure the proper anatomical tibial tunnel to achieve good PCL graft placement.