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Technical note| Volume 22, ISSUE 3, P339.e1-339.e7, March 2006

One-Stage Posterior Cruciate Ligament Inlay Reconstruction Combining Anterior Cruciate Ligament Reconstruction Following Knee Dislocation

      Abstract

      Knee dislocation is a rare but severe injury that involves damage to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral or medial ligamentous structures, and other soft tissues or bony structures surrounding the knee joint. No consensus exists regarding the best treatment method. This work presents a method of 1-stage ACL and PCL reconstruction in which a contralateral quadriceps tendon–bone autograft with tibial inlay technique is used for the PCL and contralateral hamstring tendon autograft with suspension fixation is used for the ACL. After harvesting grafts, the patient is put in the lateral decubitus position. Under arthroscopy, the femoral tunnel for the anterolateral bundle of the PCL is created using an 8-mm reamer via a prepositioned guide pin. Next, the tibial tunnel of the ACL is created with an appropriate diameter cannulated reamer. Directed by the femoral guide instrument with a 7-mm offset, a guide pin is positioned retrograde through the tibial tunnel. A reamer is then used to create a 35-mm long closed-ended femoral tunnel for the ACL. A posterior arthrotomy for the PCL inlay technique is performed. After capsulotomy, a unicortical window is created at the footprint of the PCL and the inlay graft is fixed using a 3.5mm-cancellous screw and washer. The PCL graft is then passed into the femoral tunnel. The ACL graft is passed in a retrograde fashion using the Beath pin. The ACL graft is fixed by tying with a washer on the femoral side and by tying with a screw on the tibial side. The PCL graft is then fixed on the femoral side.

      Key Words

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      References

        • Bratt H.D.
        • Newman A.P.
        Complete dislocation of the knee without disruption of both cruciate ligaments.
        J Trauma. 1993; 34: 383-389
        • Cooper D.E.
        • Speer K.P.
        • Wickiewicz T.L.
        • Warren R.F.
        Complete knee dislocation without posterior cruciate ligament disruption. A report of four cases and review of the literature.
        Clin Orthop. 1992; 284: 228-233
        • Shelbourne K.D.
        • Pritchard J.
        • Rettig A.C.
        • McCarroll J.R.
        • Vanmeter C.D.
        Knee dislocations with intact PCL.
        Orthop Rev. 1992; 21: 607-608
        • Toritsuka Y.
        • Horibe S.
        • Hiro-oka A.
        Knee dislocation following anterior cruciate ligament disruption without any other ligament tears.
        Arthroscopy. 1999; 15: 522-526
        • Dedmond B.T.
        • Almekinders L.C.
        Operative versus nonoperative treatment of knee dislocations.
        Am J Knee Surg. 2001; 14: 33-38
        • Richter M.
        • Bosch U.
        • Wippermann B.
        • Hofmann A.
        • Krettek C.
        Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations.
        Am J Sports Med. 2002; 30: 718-727
        • Shapiro M.S.
        • Freedman E.L.
        Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation.
        Am J Sports Med. 1995; 23: 580-587
        • Noyes F.R.
        • Barber-Westin S.D.
        Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis.
        Am J Sports Med. 1997; 25: 769-778
        • Wascher D.C.
        • Becker J.R.
        • Dexter J.G.
        • Blevins F.T.
        Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts.
        Am J Sports Medicine. 1999; 27: 189-196
        • Fanelli G.C.
        • Edson C.J.
        Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee.
        Arthroscopy. 2002; 18: 703-714
        • Ohkoshi Y.
        • Nagasaki S.
        • Shibata N.
        • Yamamoto K.
        • Hashimoto T.
        • Yamane S.
        Two-stage reconstruction with autografts for knee dislocations.
        Clin Orthop. 2002; 398: 169-175
        • Rios A.
        • Villa A.
        • Fahandezh H.
        • de Jose C.
        • Vaquero J.
        Results after treatment of traumatic knee dislocations.
        J Trauma. 2003; 55: 489-494
        • Harner C.D.
        • Waltrip R.L.
        • Bennett C.H.
        • Francis K.A.
        • Cole B.
        • Irrgang J.J.
        Surgical management of knee dislocations.
        J Bone Joint Surg Am. 2004; 86: 262-273
        • Goitz R.J.
        • Tomaino M.M.
        Management of peroneal nerve injuries associated with knee dislocations.
        Am J Orthop. 2003; 32: 14-16
        • Schenck R.C.J.
        • Hunter R.E.
        • Ostrum R.F.
        • Perry C.R.
        Knee dislocations.
        Instr Course Lect. 1999; 48: 515-522
        • Scheid D.K.
        Treatment of the multiple ligament injured knee and knee dislocations.
        Instr Course Lect. 2003; 52: 409-411
        • Taylor A.R.
        • Arden G.P.
        • Rainey H.A.
        Traumatic dislocation of the knee. A report of forty-three cases with special reference to conservative treatment.
        J Bone Joint Surg Br. 1972; 54: 96-102
        • Montgomery T.J.
        • Savoie F.H.
        • White J.L.
        • Roberts T.S.
        • Hughes J.L.
        Orthopedic management of knee dislocations. Comparison of surgical reconstruction and immobilization.
        Am J Knee Surg. 1995; 8: 97-103
        • Almekinders L.C.
        • Dedmond B.T.
        Outcomes of the operatively treated knee dislocation.
        Clin Sports Med. 2000; 19: 503-518
        • Shelbourne K.D.
        • Porter D.A.
        • Clingman J.A.
        • McCarroll J.R.
        • Rettig A.C.
        Low-velocity knee dislocation.
        Orthop Rev. 1991; 20: 995-1004
        • Fanelli G.C.
        • Giannotti B.F.
        • Edson C.J.
        Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.
        Arthroscopy. 1996; 12: 5-14
        • Almekinders L.C.
        • Logan T.C.
        Results following treatment of traumatic dislocations of the knee joint.
        Clin Orthop. 1992; 284: 203-207
        • Frassica F.J.
        • Sim F.H.
        • Staeheli J.W.
        • Pairolero P.C.
        Dislocation of the knee.
        Clin Orthop. 1991; 263: 200-205
        • Bergfeld J.A.
        • McAllister D.R.
        • Parker R.D.
        • Valdevit A.D.
        • Kambic H.E.
        A biomechanical comparison of posterior cruciate ligament reconstruction techniques.
        Am J Sports Med. 2001; 29: 129-136
        • Markolf K.L.
        • Zemanovic J.R.
        • McAllister D.R.
        Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods.
        J Bone Joint Surg Am. 2002; 84: 518-524
        • Berg E.E.
        Posterior cruciate ligament tibial inlay reconstruction.
        Arthroscopy. 1995; 11: 69-76
        • Miller M.D.
        • Olszewski A.D.
        Posterior cruciate ligament injuries. New treatment options.
        Am J Knee Surg. 1995; 8: 145-154
        • Thomann Y.R.
        • Gaechter A.
        Dorsal approach for reconstruction of the posterior cruciate ligament.
        Arch Orthop Trauma Surg. 1994; 113: 142-148
        • Chuang T.Y.
        • Chen C.H.
        • Chou S.W.
        • Chen Y.J.
        • Chen W.J.
        Tibial inlay technique with quadriceps tendon–bone autograft for posterior cruciate ligament reconstruction.
        Arthroscopy. 2004; 20: 331-335
        • Jarvela T.
        • Paakkala T.
        • Kannus P.
        • Jarvinen M.
        The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone–patellar tendon–bone autograft.
        Am J Sports Med. 2001; 29: 18-24
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic reconstruction of the posterior cruciate ligament.
        Arthroscopy. 2002; 18: 603-612
        • Blauth W.
        Die zweizugelige Ersatzplastik des vorderen Kreuzbandes aus der Quadricepssehne.
        Unfallheilkunde. 1984; 87: 45-51
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon–patellar bone autograft.
        Arch Orthop Trauma Surg. 1999; 119: 86-88
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendon–patellar bone autograft.
        Arthroscopy. 2000; 16: 780-782
        • Chuang T.Y.
        • Ho W.P.
        • Chen C.H.
        • Liao Y.S.
        • Chen W.J.
        Double-bundle posterior cruciate ligament reconstruction using inlay technique with quadriceps tendon–bone autograft.
        Arthroscopy. 2004; 20 (available online at www.arthroscopyjournal.org).: e23-e28