[Replacement of the posterior cruciate ligament and Clancy biceps tenodesis. Technique and results]

Operative treatment of chronic combined posterior/posterolateral knee instability is difficult. If the osseous anatomy of the leg causes a varus loading of the knee, we perform a high tibial valgus osteotomy as first step. Since 1988 we have been using a special drill guide system for reconstruction of the posterior cruciate ligament. The tunnels are drilled with the instruments placed through the notch and with image intensifier control. We prefer a bone-tendon-bone-patellar tendon autograft or allograft for replacement of the posterior cruciate ligament. The procedure is combined with a biceps tenodesis as described by Clancy. Rerouting of the biceps tendon over the origin of the lateral collateral ligament puts tension on the posterolateral corner and augments the collateral ligament. It was possible to review 16 out of 18 cases treated in this way at an average of 18 months after surgery. Preoperatively, all had a 2 to 3+ posterior drawer and a reversed pivot shift. At follow-up, 10 had a 1+ posterior drawer, 3 a 1-2+ drawer and 3 a 2+ drawer; 5 patients still had a reversed shift. KT-1000 measurements revealed 8 mm (4-12 mm) posterior translation. The Lysholm Score averaged 83 points and the Tegner Score 4.0 at follow-up.