Arthroscopic Primary Bundle-Specific Posterior Cruciate Ligament Repair with Transosseous Fixation

Posterior cruciate ligament (PCL) injuries are most commonly associated with multiligamentous knee injuries. Isolated rupture can be treated nonoperatively with bracing, but with concomitant surgical injuries or high-grade instability, operative intervention may be warranted. While historically PCL injuries were surgically managed with open primary repair, contemporary surgical options include arthroscopic primary repair and reconstruction. Appropriate patient selection is critical in avoiding residual laxity following primary repair, and innovations in advanced imaging and arthroscopic technology now allow for identification of suitable patients. In this technical vote, we describe a method for anatomic bundle-specific primary PCL repair with transosseous fixation. The appropriate patient for this procedure has a femoral-sided avulsion of 1 or both PCL bundles, presents with an acute or subacute injury, and has adequate tissue quality for bundle reapproximation to the footprint. This allows for minimally invasive, anatomic restoration of tension for each bundle.