Posterior Cruciate Ligament (PCL) Tears: PCL Reconstruction Using an All-Inside, All-SoftTissue Graft

Posterior Cruciate Ligament (PCL) Tears: PCL Reconstruction Using an All-Inside, All-SoftTissue Graft

This cadaveric surgical video demonstrates a PCL reconstruction using a soft tissue graft for the treatment of a PCL tear. The graft used in this video is taken from one of the hamstring tendons, and will be supported with a flat, reinforcing suture.

Here, we see a left knee with the inner side of the knee facing the screen. The surgeon has already made small incisions, called portals, around the knee to insert the surgical instruments to perform the procedure. An instrument called an arthroscope contains a light and camera that is used to see inside the knee joint.

The surgeon inserts a drill guide into the knee to hook onto the back of the shinbone, or tibia. This allows the surgeon to locate the point inside the knee where the graft will be placed. A small incision is made along the front of the shin to insert the other end of the guide. A drill pin is then inserted into the guide, and a drill is used to make a tunnel through the shinbone. The drill pin is removed, and the drill guide is left in place.

The surgeon then uses a shaver to clean out debris from inside the knee. A suture is passed through the tunnel and brought out of the knee. This will be used later to bring the graft into the knee. It is tied and put off to the side for now.

Next, the surgeon uses the drill guide to align the position of where the second tunnel will be made. The surgeon makes a small incision along the thigh, inserts the drill guide and drill pin, and drills a tunnel through the thigh bone. Once the drill is inside the knee, the blade at the end of the drill, seen here, flips out as it is pulled out of the knee to make a larger tunnel from the inside out. The shaver is used again to clean out debris.

Once the tunnel is drilled, a suture is passed through the tunnel and brought out of the knee. Both sutures within the drilled tunnels are retrieved and pulled out through the knee. The graft has already been prepared with sutures and contains a small metal button at 1 end. This metal button will sit on the outside of the thigh bone to hold the graft in place.

The suture passed through the tunnel in the shinbone is looped around the sutures at the bottom of the graft and used to pass the graft into the tunnel. Here, you can see the graft being pulled into the shinbone tunnel from inside the knee. Then, the suture passed through the tunnel in the thigh bone is looped around the sutures at the top of the graft and used to pass the graft into the tunnel. Here, you can see the small metal button being pulled into the thigh bone tunnel from inside the knee.

The metal button is pulled out of the knee and flipped out into place. The rest of the graft is then pulled into the thigh bone tunnel. The surgeon bends and straightens the knee to determine the final tension of the graft. Once secured, a second metal button is placed on the sutures exiting from the shinbone. The surgeon applies tension to the sutures to tighten the metal button down to the bone.

Then, the surgeon uses a drill and a bone tap to make a small hole into the shinbone below the metal button. The ends of the sutures are threaded into an anchor that is inserted into the hole to tack down the sutures in place. All sutures are tightened one more time and cut off. The skin incisions will be closed with sutures and the PCL reconstruction is complete.