2015 ISAKOS Biennial Congress ePoster #2010
The Use of All-Inside Technique for Primary Isolated PCL Reconstruction: Preliminary Results
Corrado Bait, MD, Como ITALY
Giulia Carimati, MD, Milano ITALY
Antonio Orgiani, MD, Rozzano (Mi) ITALY
Emanuele Prospero, MD, Milan ITALY
Alessandro Quaglia, MD, Milan ITALY
Piero Volpi, MD, Rozzano (Mi) ITALY
humanitas, Rozzano, Italy, ITALY
FDA Status Cleared
Summary: This technique, in our opinion, represents an excellent improvement because it allows the construction of independent bone tunnels and so an anatomical positioning of the graft
Lesions of the posterior cruciate ligament (PCL) are a source of serious instability of the knee. They are becoming more important in clinical practice because of the increase of high-energy trauma, even in sports. These lesions are considered very challenging in orthopedic field but also as far as the rehabilitative treatment; moreover there is not consensus if it must be preferred the conservative or the surgical treatment and, specifically, which technique should be chosen. In order to get a more anatomical reconstruction, it was recently introduced the all-inside technique which allows the preparation of independent tunnels and introduces a system of cortical fixation that permits a progressive tensioning of the graft.
Materials And Methods
From November 2011 to October 2013 we operated 17 patients for primary isolated PCL reconstruction with all-inside technique. They were between 14 and 56 years old and the male: female ratio was 16:1. In 11 cases we used semitendinosus and gracilis tendons; in other 6 patients we chose allograft tendons (in case of previous use of the hamstring for other surgical procedures). In 4 cases we observed meniscal tears that were therefore treated with selective meniscectomy or, where possible, the suture of the lesion. The arthroscopic technique used entails the execution of a posteromedial access that is useful to prepare the area of the tibial insertion of the original PCL. After this passage,the tibial tunnel is prepared with a special guide and a dedicated toolkit which allows a retrograde milling. Similarly, the femoral tunnel is carried out with the same out-in retrograde milling technique. The patients were evaluated at baseline (T0) with Lysholm, Tegner, and VAS and were then re-evaluated with the same scales to two years after surgery (T1).
The results are excellent in terms of functional recovery of motion, activities of daily living and return to the sport though, the complete follow-up at two years was achieved only from a limited number of patients.
This technique, in our opinion, represents an excellent improvement because it allows the construction of independent bone tunnels and so an anatomical positioning of the graft.
This surgical treatment is effective in terms of safety, reproducibility and it is of course a minimally-invasive surgical technique.