Remnant Preserving or Augmentation SB PCL Reconstruction: Tips and Tricks

Injury to the Posterior Cruciate Ligament (PCL) is thought to account for 3% to 20% of all knee ligament injuries. Accurate diagnosis of the PCL injury is the first step in determining appropriate management. Approximately 60% of PCL injuries are associated with tearing of the Posterolateral Corner (PLC) structures. When the surgery, arthroscopy PCL reconstruction, is decided then we have to think how and what the best technique will be used to reconstruct. Various techniques of PCL Reconstruction Arthroscopy are known that based on research. According the position of PCL, the procedure of reconstruction is more difficult than ACL one. If combined with PLC rupture, all the structures will be reconstructed in one step. Will be proposed the tips and tricks how to do arthroscopy remnant preserving or augmentation single bundle PCL reconstruction, such as: how to preserve the remnant, how to find the position of tibial attachment and what the landmark, how to deliver the graft into the tunnels so preventing “killer turn” on the posterior part of joint, and how to do the proper rehabilitation. By using the Posterior Medial Portal, working with Remnant Preserved of PCL Reconstruction will be made easier. Joint line of medial tibial plateau as a landmark to find the tibial tunnel. About 1.5 cm below the joint line, the point of tibial tunnel is made or directly finding the edge of the ‘shelf’ where the tunnel is made on there. The remnant will be split and the graft will be laid in between. A strong suture material is used to pull the graft with all in side technique. The tibial part of the graft goes in first through the anterolateral portal following the suture material, go into between the remnant and go into the tibial tunnel from posterior to anterior (inside out). The femoral part of the graft will go into the joint together with the wire that carrying the distal end of the graft go into the femoral tunnel. After that we make the finalization of procedure. Finally, a special rehab program is needed to get the good result of PCL reconstruction as a whole.