Reconstruction of the PCL Posterior Cruciate Ligament by Single Posterolateral Access to the Knee Reproduced Surgical Technique

Abstract

Introduction: The objective of this study is to present an anatomotographic description of a new surgical approach, making possible the combined reconstruction of injuries of the Posterior Cruciate Ligament (PCL) and the Posterolateral Complex (PLC) of the Knee, using the arthroscopic approach, combined with the technique of direct visualization. of the tibial bed (INLAY), performed through a single extended posterolateral access. Methods: ten cadaver knees were studied, simulating a videoarthroscopic stage and the proposed lateral approach. The parameters evaluated: (1) anatomical structures involved in the expansion of access (2) topographic analysis of the relationship between popliteal muscle and popliteal artery; (3) identification of the quadrilateral tibial zone for fixation under direct visualization (INLAY) (4) preservation of the posterior joint capsule (5) identification of lacerations to the vasculonervous bundle of the popliteal fossa. The analyzes were complemented through subsequent dissections, in order to obtain visualization of the results in different perspectives, and thus guarantee a better interpretation of the evaluated parameters. Results: in all dissections we demonstrated the feasibility of expanding the lateral access, using the topography of the popliteus muscle, its repair and posterior retraction allowed the creation of space necessary for the construction of the tibial tunnel in the quadrilateral area, in addition to functioning as an additional protection barrier the neurovascular structures. The preservation of the posterior joint capsule supports this hypothesis. No neurovascular lacerations were observed. Conclusion: the approach described presented reproducibility for reconstructions in combined lesions, allowing the performance of all stages of these procedures using a single access, in addition to combining all the advantages of a classic INLAY technique, obtaining an adequate area for positioning the tibial tunnel and adequate tensioning of the graft, thus minimizing failure and loosening rates. The study also establishes safety guidelines, minimizing the risks of iatrogenic injuries to the neurovascular structures of the popliteal fossa. in addition to combining all the advantages of a classic INLAY technique, obtaining an adequate area for the positioning of the tibial tunnel and adequate tensioning of the graft, thus minimizing the rates of failure and loosening. The study also establishes safety guidelines, minimizing the risks of iatrogenic injuries to the neurovascular structures of the popliteal fossa. in addition to combining all the advantages of a classic INLAY technique, obtaining an adequate area for the positioning of the tibial tunnel and adequate tensioning of the graft, thus minimizing the rates of failure and loosening. The study also establishes safety guidelines, minimizing the risks of iatrogenic injuries to the neurovascular structures of the popliteal fossa.