AANA Lab Course 913 - Advanced Knee Course-PCL Reconstructions_ Technique Options for Success Faculty Lecture

PCL Reconstructions_ Technique Options for Success Faculty Lecture_ Robert F. LaPrade, MD

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This presentation by Dr. Robert F. LaPrade from the 2019 AANA Complex Knee Course addresses advancements and techniques in posterior cruciate ligament reconstruction (PCLR). PCLR outcomes have historically been inferior to ACL reconstruction (ACLR), necessitating improved surgical and rehabilitation methods.

Key points include:

1. <strong>Anatomy and Biomechanics:</strong> The PCL consists of an anterolateral bundle (ALB) and posteromedial bundle (PMB), whose femoral and tibial attachments are precisely defined to guide anatomic reconstruction. Femoral tunnel placements for both bundles are critical and ideally spaced 12.1 mm apart. Tibial attachment is more compact, warranting a single tibial tunnel near the bundle ridge.

2. <strong>Surgical Technique:</strong> A double-bundle (DB) PCLR is recommended over single-bundle (SB) due to better restoration of posterior tibial translation (PTT) and knee stability. Femoral tunnels are created via anterolateral portals as closed sockets with exact locations relative to cartilage landmarks. A single tibial tunnel is drilled carefully using intraoperative x-rays to avoid vascular/nerve injury. Graft tensioning angles for ALB and PMB are optimized to replicate native biomechanics.

3. <strong>Clinical Outcomes:</strong> DB PCLR shows significant improvements in objective and subjective measures compared to preoperative states, with postoperative PTT reduced from around 11 mm to approximately 1-2 mm and clinical scores such as IKDC, Lysholm, WOMAC, and Tegner improved. Outcomes are comparable to ACLR at about 3.5 years. Acute PCL injuries fixed early have better results than chronic cases.

4. <strong>Rehabilitation:</strong> Early postop mobilization with prone flexion and quad activation under PCL dynamic bracing is emphasized. Non-weight bearing is maintained for 6 weeks, with gradual return to weight-bearing and sports activities over 6-12 months.

5. <strong>Additional Considerations:</strong> Tibial slope affects PCL function; flatter slopes increase PCL stress and laxity in SB PCLR, but slope has no significant impact on DB PCLR outcomes.

In summary, anatomic double-bundle PCLR is a validated, biomechanically sound, and clinically effective technique that improves knee stability and patient function, offering a reliable solution for complex PCL injuries.

Keywords

Posterior Cruciate Ligament Reconstruction

PCLR

Double-Bundle Technique

Anatomic Reconstruction

Femoral Tunnel Placement

Tibial Tunnel

Posterior Tibial Translation

Knee Stability

Rehabilitation Protocol

Tibial Slope Impact