Revision Posterior Cruciate Ligament Reconstruction with a Modified Tibial-Inlay Double-Bundle Technique

We present the surgical technique for arthroscopic revision posterior cruciate ligament (PCL) reconstruction with use of the modified tibial-inlay double-bundle method without a change of the patient's position from supine to prone.

Create the Achilles tendon allograft as a tibial bone block with two femoral bundles.

With the patient in the supine position, flexion, abduction, and external rotation of the hip and flexion of the knee 60° to 90° can provide easier access to the popliteal area.

Make anterolateral and posteromedial femoral tunnels in a shallow-shallow position using an outside-in technique for the anterolateral bundle and the inside-out technique for the posteromedial bundle.

Make the tibial tunnel with the patient supine with the hip flexed, abducted, and externally rotated and the knee flexed 60° to 90° to provide easier access to the popliteal area.

Using a wire loop, pass the graft through the knee joint posterior to the intercondylar notch into the femoral tunnel.

Use a cannulated screw with a spiked washer to secure fixation of the bone block to the tibia.

Rehabilitation after a PCL repair is generally more conservative than the accelerated rehabilitation used after an ACL repair.

In our study, twenty-two patients (twenty men and two women; mean age, 37.4 years) were treated with revision PCL reconstruction performed with the described technique and followed for a mean of 39.6 months (range, twenty-four to seventy-two months)¹⁴.IndicationsContraindicationsPitfalls & Challenges.