A New Endoscopic Posterior Cruciate Ligament Reconstruction: Minimization of Graft Angulation

PURPOSE: The purpose of this report is to present a new surgical technique for endoscopic posterior cruciate ligament (PCL) reconstruction and to elucidate the preliminary results. Surgical Technique: The concept of this surgical technique is to minimize the graft angulation at the inner edge of the bone tunnel. The tibial entry point of the guide pin is under the tibial lateral subcondylar flare approximately 1 to 2 cm anterior to the posterior cortex and 4 cm distal to the joint surface. This creates less graft angulation on the posterior aspect of the tibia. A new drill system has been devised to allow antegrade femoral drilling starting from inside the notch. This method also allows better femoral tunnel orientation. As a substitute graft material, we use autogenous hamstring tendons, and we secure them with an EndoButton (Smith & Nephew, Mansfield, MA) and post screw. METHODS: Since 1995, 40 knees have undergone endoscopic PCL reconstruction. Twenty-one patients were evaluated after a minimum follow-up of 1 year (17.9 +/- 7.7 mo). The clinical evaluation was performed using the International Knee Documentation Committee (IKDC) form. RESULTS: The range of motion was rated as A for 17 cases, B in 3 cases, and C in one case. The total anteroposterior translation (KT-1000, manual-maximum) showed a range of 1.0 to 5.5 mm (mean, 2.8 mm). The ratings of the ligament examination were A in 9 cases and B in 12 cases. The final IKDC evaluation was A (normal) in 3 cases, B (nearly normal) in 17 cases, and C (abnormal) in 1 case. CONCLUSIONS: A good clinical outcome was achieved with our endoscopic PCL reconstruction. The reduction of the graft angulation may contribute to the good results for PCL reconstruction.