A modified endoscopic technique for posterior cruciate ligament reconstruction using allograft

This article describes a modified endoscopic technique of posterior cruciate ligament reconstruction using bone-patellar tendon-bone or calcaneus tendon allografts. Three portals were used: a parapatellar anteromedial portal, a lateral anterolateral portal, and a proximal posteromedial portal. The tibial tunnel was made through the anterolateral tibial cortex 2 cm lateral to the tibial tuberosity to the posterior flat spot of the tibia 1 cm below the articular margin and just lateral to the midline. By this method, a less acute angle at the turning point of the tibial tunnel and a straighter alignment of the graft in the coronal plane can be obtained. The femoral tunnel was made through the lateral anterolateral portal without incision over the medial femoral condyle to minimize the injury to the vastus medialis obliques muscle. The 25-mm long proximal bone plug was easily passed through the tibial tunnel using a specially designed suture pusher and guided into the femoral tunnel by pulling the leading suture with the knee flexed 30 degrees. Firm graft fixation was achieved with absorbable interference screws or staples.