Arthroscopic ligament bracing of the posterior cruciate ligament

Ligament bracing is the bridging of ruptured ligament fibers with a suture cord. As the posterior cruciate ligament (PCL) has a good intrinsic healing potential due to its vascular supply, it is basically suitable for this type of treatment. The treatment of PCL ruptures depends on the type of rupture and the accompanying injuries. For isolated PCL injuries conservative treatment with orthoses is of high importance. Surgical treatment is indicated for tibial and femoral avulsions, dislocated bony avulsions, combined injuries (PCL and collateral ligament complex) and multiligament injuries (e.g., after knee dislocation). The nonresorbable suture cord can be introduced arthroscopically or by an open procedure. In the arthroscopic technique, the femoral tunnel is first drilled (4.5 mm) via a deep anterolateral portal in the insertion area of the anterolateral bundle. Then the tibial tunnel is drilled (4.5mm) in the tibial insertion area of the PCL via an anteromedial portal with the help of a closed PCL aiming device under fluoroscopic control. The suture cord is pulled in with a flexible suture loop, which is pushed under fluoroscopic control through the tibial tunnel and through the fibers of the PCL into the anterior compartment. The suture cord is fixed to the femur and tibia using an endobutton. The cord is closed with multiple knots over a second button at the exit of the tibial tunnel. Optionally, the anterior cruciate ligament can also be supplied with an internal bracing or a proximal suture anchor reattachment. After arthroscopic treatment of the central pivot, ligaments, refixation, suture repair or ligament bracing of the peripheral structures are carried out. Although the medial ligament complex shows a good intrinsic healing capacity, a primary reconstruction with tendinoplasty is recommended for the lateral or posterolateral ligamentous complex. For aftercare, the patient is mobilized with partial weight bearing (10 kg body weight) in a straight knee brace with calf support. The clinical results that have been published for this procedure so far are encouraging.