PCL INLAY RECONSTRUCTIONS

AND CASE PRESENTATION

Management of Different Scenarios of PCL Injuries

Sergio Rocha PiedadeAssociate Professor State University of Campinas – UNICAMP

Coordinator Exercise and Sports Medicine FCM/UNICAMP

Campinas - Brasil

anatomical particularities (PCL tibial insertion)

diagnosis (to investigate associate ligament injuries)

mechanical stress to the graft tendon (“Killer turn”)

PCL RECONSTRUCTION

Piedade, SR, Servien E, Lavoie F, Neyret P. Classification of Knee Laxities. The Knee Joint - Surgical Techiniques and strategies. In: Bonin M, Amendola A,Bellemans J, MacDonald S, Menetrey J. The Knee Joint. Surgical: Techniques and Strategies, Paris: Springer-Verlag 2012:p.85-93.

Badet R, Verdonk P, Piedade SR. Technique in PCL reconstruction: Mini posterior approach. In: Bonin M, Amendola A, Bellemans J, MacDonald S, Menetrey J.The Knee Joint. Surgical: Techniques and Strategies, Paris: Springer-Verlag 2012:p.411-15.

↓↓ interest of many knee surgeons

biomechanical behavior

“during the maturation phase, the graft tendon (“new ligament”)

is more vulnerable to mechanical stress and the occurrence

of graft elongation and fail (“creep phenomenon”)

Rehorn MR, Schoroer AK, Blemker SS. The passive properties of muscle fibers are velocity dependent. J Biomech. 2014 Feb;47(3):687-93

PCL RECONSTRUCTION

Piedade SR, Miranda JB e Buendia LA. Lesão do Ligamento Cruzado Posterior – Apresentação de 12 casos tratados cirurgicamente. 6° CONGRESSO DA SBCJ - Belo Horizonte/MG, l995

BTB + synthetic ligament (⇓ mechanical stress to the graft)

passage of the graft into the tibial tunnel (difficulties → bone block)

synthetic ligament fails (6 months-FU) ⇒ posterior instability returns

Personal experience with PCL reconstruction

1992

tibial tunnel technique

“killer turn”

“learning curve”

the need of changing the patient’s decubitus

2002

increasing the time of surgery;

Is it a limiting factor for one-stage bicruciate reconstruction?

PCL TIBIAL INLAY RECONSTRUCTION

BTB harvesting

dorsal decubitus

PCL TIBIAL INLAY RECONSTRUCTION

Piedade SR et al. Knee P.C.L. reconstruction: a tibial bed fixation ("INLAY") technique. Objective and subjective evaluation of a 30-cases series.

Acta ortop. bras. [online]. 2006, vol.14, n.2, pp.92-96. . Acta ortop. bras., 2006, vol.14, no.2, p.92-96.

approaching the posterior aspect of the knee joint

ventral decubitus

PCL TIBIAL INLAY RECONSTRUCTION

tibial slot 2mm narrower than the bone block (“press-fit effect”);

deeping the tibial slot (impactor);

pull-out (better control of graft tension)

preparing the tibial slot

PCL TIBIAL INLAY RECONSTRUCTION

Do we need to change the patient’s decubitus?

Stannard JP, McKean RM. Anatomic PCL Reconstruction:

The Double Bundle Inlay Technique. Operative

Techniques in Sports Medicine 2009;17(3):148-155.

Richter D, Wascher DC, Schenck Jr. RC. A Novel Posteromedial

Approach for Tibial Inlay PCL Reconstruction in KDIIIM

Injuries. Avoiding Prone Patient Positioning. Clin Orthop Relat

Res 2014; 472:2680–26902009;17(3):148-155.

in the literature

male, 32 years old;

motorcycle accident;

left knee trauma.

Physical

examination

anterior and posterior instability of left knee;

Case presentation 1 - one-stage Bicruciate reconstrution

Case presentation 1 – pre operative exam

Case presentation 1 – intra operative view

artroscopic view

Case presentation 1 – intra operative

Case presentation 1 – intra operative

male, 28 years old;

motorcycle accident;

right and left knee trauma.

Physical examination

anterior and posterior instability of left knee;

posterior instability of right knee;

Case presentation 2 - one-stage Bicruciate reconstrution

Case presentation 2 – pre operative exam

Gratf tensionning

Case presentation 2 – intra operative view

Case presentation 2 – physical exam (after graft fixation)

Case presentation 3 – intra operative view

safe and reproducible (bicruciate injury)

biomechanical concepts

Conclusion

PCL inlay reconstruction

protecting the graft in early postoperative care

Respecting our “learning curve” and “keeping the feet on the ground”

It will help us to choose the best approach for each patient!