Arthroscopic posterior cruciate ligament inlay

Chapter synopsis

Several techniques for posterior cruciate ligament reconstruction have been developed. Historically, the arthroscopic approach have been first proposed, then the inlay open approach has been popularized in order to overcome the disavantages of the arthroscopic technique. Hybrid approaches combining the arthroscopic technique with an inlay graft fixation have been recently proposed for achieving the best of the two systems.

Important points

Clinical/surgical pearls

• Supine position

• Tourniquet applied but not inflated

• Anatomical landmarks marked on the skin

• Transeptal technique mandatory for tibial inlay technique

• Posteromedial (PM) and posterolateral (PL) portals placed by using trans-illumination

• Anterolateral (AL) bundle position marked before drilling the tunnels

• Graft fixation order: always inlay first, then femoral fixation using a screw and holding the knee at 90 degrees with maximum anterior drawer

Clinical/surgical pitfalls

• Check for bleeding intraoperatively

• Watch the K-wire progression when drilling the tibial tunnel

• Avoiding cartilage scuffling when placing the femoral bay/tunnel