Double-Bundle PCL Reconstruction in the Multiple-Ligament Injured Knee

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Multi-ligament knee injuries and dislocations are severe, often involving both cruciate ligaments.
• Surgical intervention generally yields better outcomes than nonoperative management for these injuries.

Purpose of the Study:

• To describe a preferred surgical technique for bicruciate ligament reconstruction.
• To focus on a double-bundle posterior cruciate ligament (PCL) reconstruction method.

Main Methods:

• Utilized a transtibial approach for PCL tibial tunnel creation with a safety incision for precise PCL fovea palpation.
• Employed an inside-out technique for dual femoral socket creation to replicate native PCL bundles.
• Described graft passage, fixation of posteromedial (PM) and anterolateral (AL) PCL bundles, and anterior cruciate ligament (ACL) graft fixation.

Main Results:

• Biomechanical studies show double-bundle PCL reconstruction better mimics native knee kinematics.
• Clinical results indicate both single and double-bundle reconstructions enhance knee stability and patient outcomes.
• Double-bundle PCL reconstruction may offer superior objective posterior tibial stability and International Knee Documentation Committee (IKDC) scores.

Conclusions:

• Double-bundle PCL reconstruction is an efficient procedure with favorable outcomes.
• This technique may lead to less residual posterior translation and internal rotation laxity compared to single-bundle PCL reconstruction.