Arthroscopic Femoral Tensioning and Posterior Cruciate Ligament Reconstruction in Chronic Posterior Cruciate Ligament Injury

For the new arthroscopic femoral tensioning and posterior cruciate ligament (PCL) reconstruction in chronic PCL injury, we make a transtibial tunnel, using the posterior trans-septal portal, while preserving the remnant bundle of the original PCL and meniscofemoral ligament. Also, to preserve the remnant femoral fibers of the PCL and provide femoral tensioning, we manipulate the suture hook with No.1 PDS by hand so that the sharp tip penetrates the remnants of the PCL near the femoral attachment site. After pulling the sutures previously placed at the remnant PCL fibers, the notchplasty osteotome is advanced to the femoral footprint of the PCL to a depth of 1 to 2 mm from the shallow to the deep direction. Then the remnant PCL fibers are detached from the medial femoral condyle, which the authors call the artificial femoral “peel-off” tear. We drill the femoral tunnel using the outside-in technique in the anatomic place of PCL footprint, which is located 1 to 2 mm from the edge of the articular cartilage. This procedure significantly contributes to the posterior stability and proprioception of the knee joint, the remnant femoral fibers and meniscofemoral fibers are preserved to be healed with a graft and subsequently form an integrated structure.