A novel technique of graft passage in arthroscopically assisted posterior cruciate ligament reconstruction

Graft passage for cruciate reconstruction can be troublesome. Specific to the posterior cruciate ligament, difficulties can arise after tunnel preparation when trying to retrieve the graft at the back of the knee, because of the angles involved. We recommend directing a cable passer through the notch toward the tibial tunnel. Once engaged, a cerclage wire can be passed antegrade into the tunnel. Pituitary forceps can be passed to deliver the wire. The wire is looped around the pull-through suture attached to the graft and is pulled into the notch. This can then be retrieved during femoral tunnel preparation before locking. This technique can be made easier via a mini-medial arthrotomy or careful digital palpation via any posterior incisions used in the acute setting to address other injuries. To remain inside the joint capsule, we advocate the use of image intensification. The extent of soft-tissue dissection and amount of surgical time can be reduced by use of this method, and it should be added to the armamentarium of surgical procedures in existence for graft passage in posterior cruciate ligament reconstruction.