Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal with preservation of remnant PCL bundle and meniscofemoral ligament with peroneus longus

Previously, surgeons would remove the remnants and the footprints for good visualization. Here, we preserve the posterior cruciate ligament (PCL) remnant, which can increase the length of the PCL graft, preserve proprioception, ease of graft passing, and allow more anatomic positions. Innovation – We described how to avoid killer turn by pulley and rod technique. And how to avoid neurovascular damage by creating safe transportal technique, preserve footprint, and locating the anatomical tibial footprint.

Different from current practice – The position of the PCL graft was anatomic because the original PCL insertion was intact. The advantages of our technique are the creation of transseptal portals with visualization of the posterior compartment and killer turn prevention and we have also noticed marked reduction of operative time with an average of 90 min [Video 1].

Description – Create posteromedial portal with transillumination technique, insert rod from posteromedial portal, and create posterolateral portal, after transseptal clearance, tibial footprint located and tibial tunnel drilled and pulley inserted underneath the graft to avoid killer turn, and help in easy passage of graft.

The advantages of our technique are the creation of transseptal portals with visualization of the posterior compartment and killer turn prevention and we have also noticed marked reduction of operative time with an average of 90 min. A disadvantage is that the critical angle still exists, but we can lessen it with the deep flexion knee.

A disadvantage is that the critical angle still exists, but we can lessen it with the deep flexion knee. Hence, PCL reconstruction with remnant augmentation should be the future of transtibial PCL reconstruction.