Arthroscopic Transtibial Tunnel Posterior Cruciate Ligament Reconstruction

The goals leading to successful posterior cruciate ligament (PCL) reconstruction surgery include identification and treatment of associated pathology such as posterolateral instability, posteromedial instability, and lower extremity malalignment. The use of strong graft material, properly placed tunnels to approximate as closely as possible the PCL insertion sites, and minimization of graft bending also enhance the probability of PCL reconstruction success. In addition, mechanical graft tensioning, primary and backup PCL graft fixation, and the appropriate postoperative rehabilitation program are also necessary ingredients for PCL reconstruction success. Both single-bundle and double-bundle PCL reconstruction surgical techniques are successful when evaluated with stress radiography, KT-1000 arthrometer measurements, and knee ligament rating scales. Indications for double-bundle PCL reconstruction as of this writing include severe hyperextension of the knee and revision PCL reconstruction. In combined PCL, anterior cruciate ligament, medial- and lateral-side knee injuries (global laxity), 2-18-year postsurgical results revealed very successful posterior cruciate ligament reconstruction using the arthroscopic transtibial tunnel surgical technique. The purpose of this article is to describe the arthroscopic transtibial tunnel posterior cruciate ligament reconstruction surgical technique, and present the author’s results with this surgical procedure.