Abstract
Posterior cruciate ligament reconstruction is always a challenge to the orthopaedic
surgeon. It is difficult when the anterior cruciate ligament (ACL) is intact. We propose
a new guide system through the posteromedial portal, avoiding ACL damage. The arthroscope
is inserted anteromedially (30°), and anterolateral portals are used for instruments
to confirm the diagnosis and inspect the joint to search for and treat associated
lesions that may appear eventually. The posteromedial portal is located posterior
to the collateral medial ligament superficially, adjacent to a portion of the posteromedial
femoral condyle, which is located 1 cm proximal to the posteromedial tibial plate
(where a skin marker must be used before insufflation of the knee). Our system is
designed with an articular end in the form of a rasp, which helps prepare the area
of the posterior tibia to be stripped before the tibial tunnel is drilled while being
protected by the drill guide; this simplifies the preparation and creation of the
tibial tunnel via a single device, which can be done with a 30° arthroscope but is
easier with a 70° arthroscope. The guide system through the posteromedial portal is
used to determine a fixed 40° angle of approach to the tibia in the anteroposterior
direction to drill the tibial tunnel; this approach is particularly helpful in the
presence of an intact ACL. The graft into the femoral tunnel is fixed with a bioabsorbable
interference screw whose size must fit the graft and the tunnel walls. Before tibial
graft fixation, it is necessary to reduce the posterior drawer. In the tibia the bundle
corresponding to the anterolateral portion is tensioned and fixed under flexion, followed
by the posteromedial portion in extension, by means of a Bottom Fix system (Smith
& Nephew, Mayfield, MA) placed near the exit of the tibial tunnel.
Key Words
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Article info
Publication history
Published online: January 20, 2007
Footnotes
The authors report no conflict of interest. This study was performed at the Center for Orthopedics and Rehabilitation in Sports, Heart Hospital, São Paulo, Brazil.
Cite this article as: Abdalla RJ, Pacagnan AV, Loyola HAG, Cohen M, Camanho GL, Forgas A. A proposal for a new tibial guide system for posterior cruciate ligament reconstruction. Arthroscopy 2007;23:793.e1-793.e4 [doi:10.1016/j.arthro.2006.08.027].
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
