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Updated: Jun 8, 2026
Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach
Published on: October 20, 2023
[Double-bundle technique--anatomic reconstruction of the posterior cruciate ligament]
Alexander C Rauch1, Philip B Schöttle, Knut Beitzel
1Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München. sportortho@lrz.tu-muenchen.de
Objective:
To improve the posterior translational stability of the knee joint by anatomic reconstruction of the posterior cruciate ligament in double-bundle technique. The functional bundles are reconstructed by native grafts from semitendinosus and gracilis muscles. The grafts are fixed with bioabsorbable screws in aperture technique.
Indications:
Symptomatic tears of the posterior cruciate ligament (classification by Harner) or chronic posterior or posterolateral instabilities; combined instabilities may need extended operative procedure.
Contraindications:
Open growth plate. Fixed posterior drawer position. Nonjustifiable operative risks. Decline of the operation by the patient. Noncompliance.
Surgical Technique:
Graft harvest of the semitendinosus and gracilis tendons via a 3-cm skin incision parallel to pes anserinus. Preparation, multilooping and arming of the tendons with sutures, arthroscopy, resection of the stump of the posterior cruciate ligament and clearing of its origin and insertion (using an additional posteromedial portal). Tunnel placement by means of aiming devices in the following order: femoral anterolateral, femoral posteromedial, and tibial (by accurate protection of the popliteal structures). Passing in the bundles, fixation in biomechanical functional positions in the following order: posteromedial bundle femoral (90° flexion), tibial (extension 0°), and anterolateral bundle femoral (90° flexion) with bioabsorbable interference screws.
Postoperative Management:
6 weeks PTS orthesis for 24 h/7 days with partial weight bearing (20 kg). Increased weight bearing from 7th postoperative week with PCL support orthesis during daytime and PTS orthesis during nighttime for further 6 weeks. Return to sports after 6 months at the earliest, no contact sports and competition for at least 9 months.
Results:
First studies show positive results after reconstruction of the posterior cruciate ligament in double-bundle technique. A comparison with the single-bundle technique with a sufficient number of cases has not been published yet.