0:00

Finally, um, in the last couple minutes I'll talk about,

0:03

uh, posterior cruciate ligament reconstructions.

0:06

These are not commonly performed usually in the setting

0:10

of high grade tears.

0:11

These, uh, reconstructions will be performed in high

0:14

performance athletes,

0:16

but even, uh, high grade tears in, um, uh, you know, kind

0:20

of normal ambulatory people can be treated conservatively.

0:24

Now, um, PCL as you know, is important

0:27

for posterior translational stability, uh,

0:30

but is also important for normal patello femoral kinematics.

0:34

And patients who are chronically PCL deficient can, uh,

0:38

result in accelerated patello femoral

0:41

and medial compartment oa.

0:44

There are different reconstruction issues unique

0:46

to the PCL having to do with the, uh, wave,

0:49

the PCL anatomy is arranged

0:52

and the ways the tunnels have to be placed.

0:54

So, let's just start with some radiographs.

0:58

If you're going through a stack of radiographs

1:00

on a busy day, you might wanna call this an anterior

1:03

cruciate ligament reconstruction, no complications,

1:05

normal joint spaces, next case.

1:08

But if you look more closely, you'll notice

1:10

that the femoral interference screw is on the medial side.

1:13

Whereas an ACL reconstruction, you would expect it

1:16

to come on the lateral side.

1:18

And if you follow the tibial, the tibial tunnel,

1:20

it moves from anterior

1:22

to posterior towards the posterior knee.

1:24

So this is indeed is a PCL reconstruction.

1:29

Now, a different variety

1:30

of techniques have been described in the literature.

1:32

More commonly, what you'll see these days is a, uh,

1:35

trans osseous technique.

1:38

The problem that they have to deal with is this kind

1:40

of what's called a killer turn,

1:41

where you have the sharp turn to get to the femoral tunnel.

1:44

Older techniques, um, um, here is, uh,

1:48

shown is the onlay technique,

1:50

which is obviously much more complicated

1:52

'cause you have to dissect through the Pope Teal

1:54

neurovascular bundle just to get to this area.

1:59

As far as optimal tunnel placement, again,

2:01

bloomin SAT's line is our friend

2:03

and the literature, it has been suggested

2:06

that in the first quartile

2:08

of bloomin SAT's line is the best position for the, uh,

2:13

posterior CIA ligament.

2:14

And here a patient is, this one was placed kind

2:17

of more in the midway point of bloom and SATs line,

2:20

and this patient had grade three laxity.

2:24

Here's a, uh, an example

2:25

of posterior CIA ligament reconstruction for case files.

2:29

You can see the trans osseous tibial tunnel,

2:32

this one actually coming posterior to the cortical margin

2:35

of the proximal tibia.

2:36

And we can see in relation tolum and SATs line.

2:39

This has an optimal tunnel placement.

2:43

Here's just another example from our case files.

2:46

Uh, pretty normal looking posterior

2:47

cruciate ligament reconstruction.

2:49

Again, using a trans osseous technique.

2:52

Be a little careful when you have metallic suby artifact,

2:55

not over calling areas

2:56

of increased signal within a reconstructive

2:59

Ligament. But

3:00

for the most, uh, part, this ligament is intact.

3:05

Post-op complications for PCL, similar to ACL, any types

3:10

of graft failure or laxity, neurovascular damage,

3:13

especially the popliteal neurovascular bundle.

3:16

I showed you that case of a patient

3:18

who had an aberrant tibial anterior tibial artery.

3:22

You wanna look for those on your preoperative imaging

3:25

and similar findings as to ACL reconstructions.

3:30

So with that, I'd like to conclude ligament reconstruction.

3:33

Um, the surgical techniques are constantly involving,

3:37

especially with the renewed interest in those lateral extra

3:40

articular tenodesis.

3:42

And MRI in my mind,

3:44

also compliments radiography when evaluating the status

3:48

of these reconstructed ligaments.

3:50

And with that, I'd like to thank you for your attention. I.