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Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach

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Abstract

Introduction

Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also thought to lower the risk of neurovascular injuries. The aim of this study was to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute.

Methods

This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation.

Results

A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2 years. Mean time from injury to surgery was 20 months. Mean follow-up was 41.2 months (range, 13–72 months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p < 0.001). Knee range of movement was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p = 0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p < 0.001). KOOS score improved from 65.1 to 77.2 (p = 0.196). One patient required manipulation under anesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at the final follow-up.

Conclusion

Greater visualization of the PCL tibial attachment minimizes the ‘killer turn’ giving a huge advantage to this technique. Arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study, it shows that post-operative clinical and functional outcomes improved significantly.

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Authors and Affiliations

  1. Trauma & Orthopaedic Department, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia

    Shahir Shahibullah, Suhari Juhari, Farhan Yahaya, Nur Dini Mohd Yusof, Ahmad Fauzey Kassim, Suresh Chopra & Veenesh Selvaratnam

  2. Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia

    Veenesh Selvaratnam

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  1. Shahir Shahibullah
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Correspondence to Veenesh Selvaratnam.

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This study has been approved by the local institutional ethics committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. 

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Shahibullah, S., Juhari, S., Yahaya, F. et al. Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach. JOIO 57, 1134–1138 (2023). https://doi.org/10.1007/s43465-023-00893-8

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