Tibial tunnel preparation in posterior cruciate ligament (PCL) reconstruction A technical tip to lessen the stress

BackhroundsTo introduce a technical tip for the preparation of tibial tunnel in PCL reconstruction toreduce the chance of popliteal artery injury and to decrease the duration of the surgery.MethodsEighteen patients who underwent PCL reconstructions at our institution between 2016and 2017 were included in this study. In all patients, the PCL tibial aimer device insertedfrom anteromedial portal and its tip aimed 9-8 mm below shiny white fibers in PCL facet.The smooth guide pin then was inserted from anteromedial tibial cortex and advanced justto the posterior cortex but not through it, based on measurement of tibial tunnel length.Thereafter reaming was done over the guide pin. As the pin was engaged in the posteriorcortex we were sure that it would not run before reamer to the popliteal fossa. We removethe pin when the reamer touched the posterior cortex and then continue reaming untilreamer’s head appeared in the PCL facet. Other steps of standard arthroscopic PCLreconstruction were done. We did CT scan evaluation of all patients.ResultsThe mean age of the patients in this study were 3 -+(25y). The mean duration of surgerywas 95 minutes. There was no vascular injury. The position of tibial tunnel in all cases wereaccurate. The mean distance between the center of the tibial tunnel to CGD(Champagne_glass Drop-off ) the posterior cortex of tibia was 7.42 mm (range from 4.6 to 10.4 mm).ConclusionsOur study showed that avoiding the penetration of posterior cortex of the tibia by meansof the pin during tibial tunnel preparation for PCL reconstruction is a safe, reproducible andtime saving technique. Using this technique eliminates the need for fluoroscopy during theprocedure.