POSTERIOR CRUCIATE LIGAMENT SURGICAL 
TECHNIQUE AND PRELIMINARY RESULTS.

G. Agar, D. Jaffe, N. Halperin
Medical Center, Zerifin, Israel.

Presented at the annual meeting of the Israeli Orthopedic Society, Haifa, Nov. 1997.

New light has been shed on the natural history of injury to the posterior cruciate ligament, as well as on its complex anatomy and functional mechanical behavior.

The natural history of injuries of the posterior cruciate ligament has been a matter of debate. There was a general consensus in the orthopaedic literature that patients who have an isolated injury of the ligament usually do well when treated non-operatively.

Several reports have challenged this assumption, because patients had episodes of giving-way, as well as anterior knee pain and early degenerative changes. The decision as to whether or not to treat isolated tears of the posterior cruciate ligament operatively is still a matter of debate.

Traditionally, most authors have recommended non-operative care for all isolated injuries of the ligament. More recently, however, others have advised an operation for young, athletic individuals or for symptomatic patients who have more than ten to fifteen millimeters of posterior tibial translation. Although an open procedure may be used for reconstruction of the posterior cruciate ligament, arthroscopically assisted techniques have been described recently and hold promise for reduced operative morbidity and improved clinical results.
We present the surgical technique employed by our department to treat P.C.L. injuries. By arthroscopic assistance we locate the insertion sites of the P.C.L, drill tunnels, use the middle 2cm of the quadriceps tendon as a graft, and pass it from the femoral tunnel to the tibial tunnel. Fixation is achieved proximally by an interference screw, and distally by staples.

Fifteen patients underwent this procedure in the past year. All patients had isolated tear of the P.C.L., posterior drawer sign (grade III), and all complained of instability. Our follow-up is too short to draw any conclusion although both clinical and subjective short-term results are encouraging.