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Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament

  • Symposium: Complex Knee Ligament Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2–3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.

Description of Technique

As part of a reconstruction/repair of a multiligament-injured knee, we performed arthroscopic primary repair of the posterior cruciate ligament by passing Bunnell-type stitches into the substance of the ligament using a reloadable suture passer. We then passed the sutures through drill holes into the femoral footprint of the ligament and tied them over a bony bridge.

Patients and Methods

We retrospectively reviewed three patients with posterior cruciate ligament tears associated with a multiligament-injured knee. All patients had posterior cruciate ligament soft tissue avulsions or “peel off” injuries diagnosed by MRI. The described repair technique was used to repair the posterior cruciate ligament avulsion. Minimum followup was 64 months (mean, 68 months; range, 64–75 months). ROM, stability testing, and functional outcome scores (Lysholm and modified Cincinnati) were recorded.

Results

Mean ROM was 0° to 127°. Posterior drawer testing was negative in all three patients. The mean Lysholm score was 92 and the mean modified Cincinnati score was 94. Followup MRI confirmed ligament healing in all patients.

Conclusions

We believe arthroscopic posterior cruciate ligament repair for soft tissue peel off injuries is a technique that, when applied to carefully selected patients, may be helpful to the surgeon treating patients with a multiligament-injured knee.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Weill Cornell College of Medicine and Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Gregory S. DiFelice MD

  2. Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA

    Micah Lissy MD

  3. Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA

    Paul Haynes MD

Authors
  1. Gregory S. DiFelice MD
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  2. Micah Lissy MD
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  3. Paul Haynes MD
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Corresponding author

Correspondence to Gregory S. DiFelice MD.

Additional information

One of the authors (GSD) certifies that he has or may receive payments or benefits from the Speaker’s Bureau for Arthrex, Inc (Naples, FL).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Jacobi Medical Center, Bronx, NY, and Lenox Hill Hospital, New York, NY.

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DiFelice, G.S., Lissy, M. & Haynes, P. Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament. Clin Orthop Relat Res 470, 861–868 (2012). https://doi.org/10.1007/s11999-011-2034-4

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