Reconstruction of the posterior cruciate ligament. Indication and technique

The main function of the posterior cruciate ligament (PCL) is stabilization of the tibia against posterior subluxation in flexion of the knee. Isolated PCL deficiency causes increased subluxation of the knee joint in flexion, which can be compensated by the quadriceps muscle. Therefore, patients do not initially suffer from instability. Nevertheless, there is a high incidence of osteoarthritis after 10-20 years due to higher stress in the medial and retropatellar compartments. Osseous avulsion of the PCL from the tibia has a good prognosis when treated by bony fixation. Ruptures of the ligament should not be treated by suture repair. Long-term results do not show a better prognosis after surgery isolated PCL tears. The authors have developed a special arthroscopic technique for PCL replacement featuring femoral and tibial fixation of the grafts with resorbable cross pins. Osseous abnormalities and posterolateral rotary instability must be addressed in complex chronic instabilities of the knee. Osteotomy is indicated in the presence of a varus morphotype. Reconstruction of the posterolateral capsular ligament complex is recommended if posterolateral instability exists.