Technical Note| Volume 23, ISSUE 4, P444.e1-444.e6, April 2007

Arthroscopic Posterior Cruciate Ligament Augmentation Using an Autogenous Hamstring Tendon Graft and the Posterior-Posterior Triangulation Technique

Published:January 08, 2007DOI:


      We describe a modification of the currently practiced arthroscopic posterior cruciate ligament (PCL) reconstruction techniques. We augmented the injured PCL with quadrupled autogenous hamstring tendon grafts using the arthroscopic posterior-posterior triangulation method and a single-incision transtibial approach. The tibial drill guide was introduced through the anteromedial portal and positioned onto the fossa for the PCL on the tibia under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 10 mm posterior to the articular cartilage of the medial femoral condyle by use of the anterior cruciate ligament Beath pin (Arthrex, Naples, FL) introduced through the far-inferior anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems (DePuy Mitek, Raynham, MA) at both the ends. The arthroscopic posterior-posterior triangulation method provides adequate exposure of the posterior knee compartment; this allows for convenient instrumentation and safe and accurate placement of the bony tunnels with preservation of the PCL remnants. We believe that retention of the remnant PCL fibers is biologic and contributes to earlier healing and strengthening of the tendon graft.

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        • Morgan C.D.
        • Kalman V.R.
        • Grawl D.M.
        The anatomic origin of the posterior cruciate ligament: Where is it?.
        Arthroscopy. 1997; 13: 325-331
        • Wang C.J.
        • Chen H.H.
        • Chen H.S.
        • Huang T.W.
        Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: A cadaveric knee study.
        Arthroscopy. 2002; 18: 496-501
        • Kim W.Y.
        • Shafi M.
        • Kim Y.Y.
        • Kim J.Y.
        • Cho Y.K.
        • Han C.W.
        Posteromedial compartment cement extrusion after unicompartmental knee arthroplasty treated by arthroscopy: A case report.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 46-49
        • Shelbourne K.D.
        • Jennings R.W.
        • Vahey T.N.
        Magnetic resonance imaging of posterior cruciate ligament injuries: Assessment of healing.
        Am J Knee Surg. 1999; 12: 209-213
        • Ahn J.H.
        • Yang H.S.
        • Jeong W.K.
        • Koh K.H.
        Arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers: Clinical results of minimum 2-year follow-up.
        Am J Sports Med. 2006; 34: 194-204
        • Fowler P.J.
        • Messieh S.S.
        Isolated posterior cruciate ligament injuries in athletes.
        Am J Sports Med. 1987; 15: 553-557
        • Race A.
        • Amis A.A.
        The mechanical properties of the two bundles of the human posterior cruciate ligament.
        J Biomech. 1994; 27: 13-24
        • Shino K.
        • Nakagawa S.
        • Nakamura N.
        • Matsumoto N.
        • Toritsuka Y.
        • Natsu-ume T.
        Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: One-incision technique with Endobutton.
        Arthroscopy. 1996; 12: 638-642