Skip to main content
SpringerLink
Log in

Accessory anterolateral portal in arthroscopic PCL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the clinical and radiological results of arthroscopic PCL reconstruction using an accessory anterolateral portal for femoral tunneling and to compare these results with those of the conventional technique.

Methods

We retrospectively reviewed the clinical and radiological results for 57 patients who underwent PCL reconstruction, including 31 patients who underwent arthroscopic PCL reconstruction with an accessory anterolateral portal (group A) and 26 patients who underwent conventional arthroscopic PCL reconstruction (group B). Lysholm score, IKDC score, simple radiographs (AP and lateral), and posterior drawer test results were evaluated preoperatively and at 3 years postoperatively.

Results

No major complication was observed in group A. However, posterior cortical disruption due to improper placement of the femoral tunnel was observed in one patient in group B. The mean Lysholm knee scores increased from 41.5 ± 4.8 preoperatively to 92.5 ± 6.2 at final follow-up in group A (P < 0.001), and from 43.5 ± 3.4 preoperatively to 88.5 points ± 3.7 in group B (P = 0.002). Posterior stress radiographs with a KT-1000 showed that the mean side-to-side differences improved from 13.79 ± 5.1 mm preoperatively to 3.1 ± 0.7 mm postoperatively in group A and from 12.68 ± 6.3 mm preoperatively to 3.5 ± 0.5 mm postoperatively in group B. The sensitivity and specificity of the placement and direction of the femoral tunnel were significantly higher in group A than group B (P = 0.002).

Conclusion

Arthroscopic PCL reconstruction with an accessory anterolateral portal can provide a better surgical view than the conventional technique, and this can minimize the problems associated with femoral tunneling, such as inappropriate and inconsistent placement of the tunnel, abnormal angulation, and sliding of the guide tip. Moreover, this approach may have a shorter operative time and a better functional recovery than the conventional technique.

Level of evidence

Retrospective comparative study, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ahn JH, Lee YS, Choi SH, Chang MJ, Lee DK (2011) Single-bundle transtibial posterior cruciate ligament reconstruction using a bioabsorbable cross-pin tibial back side fixation. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1769-5

  2. Amis AA, Bull AM, Gupte CM, Hiijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posteolateral, posteomedial and meniscofemoral ligament. Knee Surg Sports Traumatol Arthrosc 11(5):271–281

    Article  PubMed  CAS  Google Scholar 

  3. Apspingi S, Bull AM, Deeham DJ, Amis AA (2009) Review: femoral tunnel placement for PCL reconstruction in relation to the PCL fibre bundle attachments. Knee Surg Sports Traumatol Arthrosc 17(6):652–659

    Article  Google Scholar 

  4. Bach BR Jr, Aadalen KJ, Mazzocca AD (2004) An Accessory portal for posterior cruciate ligament tibial insertion visualization. Arthroscopy 20(suppl 2):155–158

    PubMed  Google Scholar 

  5. Barber FA, Dockery WD, Hrnack SA (2011) Long-term degradation of a poly-lactide co-glycolide/b-tricalcuim phosphate biocomposite interference screw. Arthroscopy 27(5):637–643

    Article  PubMed  Google Scholar 

  6. Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11(1):69–76

    Article  PubMed  CAS  Google Scholar 

  7. Bosdekis G, Abisafi C, Christel P (2009) Effect of knee flexion angle on length and orientation of posteolateral femoral drilled through anteromedial portal during anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 25(10):1108–1114

    Article  Google Scholar 

  8. Dennis MG, Fox JA, Alford JW, Havden JK, Bach BR Jr (2004) Posterior cruciate ligament reconstruction: current trends. J Knee Surg 17(3):133–139

    PubMed  Google Scholar 

  9. Ettinger M, Wehrhahn T, Petri M, Liodakis E, Olender G, Albrecht UV et al (2012) The fixation strength of tibial PCL press-fit reconstruction. Knee Surg Sports Traumatol Arthrosc 20(2):308–314

    Article  PubMed  CAS  Google Scholar 

  10. Fanelli GC, Berk JD, Edson CJ (2010) Current concepts review: the posterior cruciate ligament. J Knee Surg 23(2):61–72

    Article  PubMed  Google Scholar 

  11. Gancel E, Maqnussen RA, Lustiq S, Demey G, Neyret P, Servien E (2011) Tunnel position following posterior cruciate ligament reconstruction: An in vivo computed tomography analysis. Knee. doi:10.1016/j.knee.2011.04.003

  12. Garofalo R, Jolles BM, Moretti B, Siegrist O (2006) Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of 2 years’ follow-up. Arthroscopy 22(12):1331–1338

    Article  PubMed  Google Scholar 

  13. Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL (2000) Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 28(2):144–151

    PubMed  CAS  Google Scholar 

  14. Hatayama K, Higuchi H, Kimura M, Kobayashi Y, Asagurmo H, Takagishi K (2006) A comparison of arthroscopic single- and double-bundle posterior cruciate ligament reconstruction: review of 20 cases. Am J Orthop 35(12):568–571

    PubMed  Google Scholar 

  15. Johnson LL (1977) Comprehensive arthroscopic examination of the knee. CV Mosby, St. Louis

    Google Scholar 

  16. Kim SJ, Park IS (2005) Arthroscpic reconstruction of the posterior cruciate ligament using tibial-inlay and double bundle technique. Arthroscopy 21(10):1271

    PubMed  Google Scholar 

  17. Lysholm J, Gillquist J (1981) Arthroscopic examination of the posterior cruciate ligament. J Bone Joint Surg Am 63(3):363–366

    PubMed  CAS  Google Scholar 

  18. MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22(3):320–328

    Article  PubMed  Google Scholar 

  19. Margheritini F, Rihn JA, Mauro Cs, Stabile KJ, Woo SL, Harner CD (2005) Biomechanics of initial tibial fixation in posterior cruciate ligament reconstruction. Arthroscopy 21(10):1164–1171

    Article  PubMed  Google Scholar 

  20. Mariani PP, Adriani E, Bellelli A, Maresca G (1999) Magnetic resonance imaging of tunnel placement in posterior cruciate ligament reconstruction. Arthroscopy 15(7):733–740

    Article  PubMed  CAS  Google Scholar 

  21. McGuire DA, Hendricks SD (2010) Comparison of anatomic versus nonanatomic placement of femoral tunnels in Achilles double-bundle posterior cruciate ligament reconstruction. Arthroscopy 26(5):658–666

    Article  PubMed  Google Scholar 

  22. Panchal HB, Sekiya JK (2011) Open tibial inlay versus arthroscopic transtibial posterior cruciate ligament reconstructions. Arthroscopy 27(9):1289–1295

    Article  PubMed  Google Scholar 

  23. Patel DV, Allen AA, Warren RT, Wickiewicz TL, Simonian PT (2007) The nonoperative treatment of acute, isolated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate-term follow-up study. HSS J 3(2):137–146

    Article  PubMed  Google Scholar 

  24. Petersen W, Lenshchow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T (2006) Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 34(3):456–463

    Article  PubMed  Google Scholar 

  25. Race A, Amis AA (1998) PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 80(1):173–179

    Article  PubMed  CAS  Google Scholar 

  26. Rossi R, Bonasia DE, Assom M, Bruzzone M, Castoldi F (2007) Cross-pin femoral fixation in PCL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 15(10):1194–1197

    Article  PubMed  Google Scholar 

  27. Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD (2005) Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy 21(9):1042–1050

    Article  PubMed  Google Scholar 

  28. Seon JK, Song EK (2006) Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 22(1):27–32

    Article  PubMed  Google Scholar 

  29. Shearn JT, Grood ES, Noyes FR, Levy MS (2005) One- and two-strand posterior cruciate ligament reconstruction: cyclic fatigue testing. J Orthop Res 23(4):958–963

    Article  PubMed  Google Scholar 

  30. Shearn JT, Grood ES, Noyes FR, Levy MS (2004) Two-bundle posterior cruciate ligament reconstruction: how bundle tension depends on femoral placement. J Bone Joint Surg Am 86-A(6):1262–1270

    PubMed  Google Scholar 

  31. Shon OJ, Lee DC, Park CH, Kim WH, Jung KA (2010) A comparison of arthroscopically assisted single and double bundle tibial inlay Reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2(2):76–84

    Article  PubMed  Google Scholar 

  32. Spiridonov SI, Slinkard NJ, LaPrade RF (2011) Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J Bone Joint Surg Am 93(19):1773–1780

    Article  PubMed  Google Scholar 

  33. Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Yamamoto Y, Toh S (2011) Biomechanical Evaluation of an Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy 28(2):264–271

    PubMed  Google Scholar 

  34. Uribe JW, Vargas L, Leo BM (2010) Arthroscopic PCL reconstruction with a novel all-inside femoral fixation device: a single-incision technique. Orthopedics 33(2):92–97

    Article  PubMed  Google Scholar 

  35. Yasuda K, Kitamura N, Kondo E, Hayashi R, Inoue M (2009) One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons. Knee Surg Sports Traumatol Arthrosc 17(7):800–805

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Jae-Man Kwak, MD for technical assistance.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34 Amnam-Dong, Seo-gu, Busan, 602-702, Republic of Korea

    Gun Woo Lee, Soo-Jin Jang, Young Choi & Jung-Hwan Son

Authors
  1. Gun Woo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soo-Jin Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jung-Hwan Son
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung-Hwan Son.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, G.W., Jang, SJ., Choi, Y. et al. Accessory anterolateral portal in arthroscopic PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 21, 1043–1049 (2013). https://doi.org/10.1007/s00167-012-2130-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2130-3

Keywords

Search

Navigation