Endoscopic Posterior Cruciate Ligament Reconstruction Using a Quadrupled Hamstring Graft and Endobutton(r): Preliminary Report of a New Technique

Lee, Kwang Won; Kim, Young Wan; Choy, Won Sik

Abstract

We present our technique for reconstruction of the posterior cruciate ligament (PCL) using the quadrupled hamstring tendons with EndoButton(Acufex Microsurgical, Mansfield, MA). This paper describes the surgical technique of the procedures and reports the preliminary results in 10 patients with a more than 12 months follow-up. There were 8 males and 2 females ranging in age from 17 to 37 years (average 25 years). The average time from injury to operation was 3 weeks (range; 2 weeks to 4 weeks). Of ten patients, 6 were classified as an isolated tear, 2 were associated with lateral collateral ligament tears. A torn meniscus was present in 2 cases. We used one-incision technique. The results of these PCL reconstructions with a minimum follow-up of 12 months are as follows. Patients were evaluated preand postoperatively using the Lysholm, and Hospital for Special Surgery Knee ligament rating scales. Average knee ligament evaluation scores were Lysholm preoperative 48, postoperative 87.6; and Hospital for Special Surgery preoperatively 33.5, postoperative 88.8. We chose the semitendinosus and gracilis tendons with EndoButton fixation for PCL reconstruction for specific reasons: (1) No injury to the extensor mechanism and (2) Easy passage of the graft through the tibial tunnel. (3) The problem about the screw and patellar bone-tendon-bone can be resolved. (4) It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle. (5) When rupture of the PCL is associated with ACL tear, each ligament should be reconstructed. In such a case, we preserve patellar tendon for reconstruction of the ACL, The technique presented here is not applicable to all individuals requiring PCL reconstruction but does provide significant advantages to those patients for whom it is utilized. Although the clinical results are very promising at this length of follow up, long-term study is required to evaluate our PCL reconstruction procedure more precisely.