Arthroscopic Primary Repair of Posterior Cruciate Ligament Injuries

Posterior cruciate ligament (PCL) injury can present either as an isolated tear or in the setting of a multiligament-injured knee. Most PCL injuries are midsubstance tears and 10%-40% of tears are either bony avulsion or soft tissue avulsion of the femur or tibia. PCL reconstruction is the mainstay for treatment of midsubstance tears, but primary arthroscopic PCL repair can be considered for avulsion tears. Although the literature on PCL injuries and especially PCL repair is scarce, some studies show good results with primary repair techniques. In this article, we describe the surgical technique of arthroscopic primary PCL repair by passing Bunnel-type stitches into the ligament using a reloadable suture passer. Sutures are then fixed either to bone with a suture anchor technique or by passing the sutures through drill holes at the femoral footprint and tying them over a bony bridge or button. Patient selection and surgical indications, including radiographic assessment, are critical to successfully using this technique. The areas of concern and most common pitfalls of this technique are discussed, as well as the postoperative care regimen and reported clinical results to date. When these steps are carefully optimized, successful patient outcomes can be achieved. Although this technique is not meant to be the mainstay of surgical PCL treatment, we believe that the arthroscopic primary PCL repair technique is quite useful in select clinical situations, and should be in the armamentarium of every surgeon treating multiligament-injured knee or isolated PCL injuries.