Cruciate Ligament Repair and Reconstruction Surgery
Unlike the an ACL tear, when the tearing of a PCL is less severe, athletes usually undergo repair surgery. When the tear is severe, the athlete must be operated on to recover function and resume their activity in sports. The tear can be repaired by reattaching the torn fibers to each other. If there aren't enough fibers for reattachment, the PCL should be reconstructed.
If there is a good about of good tissue left in the knee, the surgeon usually performs repair surgery. Repair surgery is as follows:
1) The surgeon enters the knee arthroscopically.
2) A suture punch is then used to pass sutures into the remaining PCL.
3) The sutures are then guided through a tunnel that is bored from the insertion site of the PCL through the femoral condyle, exiting on the medial border of the femur.
4) The sutures are then tied in a fisherman's slip knot down to the bone, and then to each other.
5) After this, any associated capsular tearing is then repaired.
If it is determined that there isn't enough good tissue to salvage the PCL, reconstruction surgery is performed.
The surgeon inspects the knee and removes the remains of the old
PCL using an arthroscopic shaver.
2) The graft which is used for reconstruction is harvested arthroscopically and prepared for the replacement. Usually the patellar tendon or the semitendonosis and gracilis tendon autografts are used in athletes.
3) After harvesting the tissue, a hole is drilled from the front of the tibia diagonally into the knee and ends up where the ACL attaches to the top of the shin. Next, the sugeon drills a hole in the femur between the two heads running diagonally and up from the middle to the outside. The PCL surgery differs from the ACL in that the bones are drilled from opposite sides. If both were to be performed at ones, the drills would form an X in the knee. This to simulate the actual way the ACL and PCL run in the knee.
4) The harvested replacement is attached to two long sutures, attached to the drill bit, and pulled into place through the holes which were just drilled.
5) The new ligament is then held into place by two bioabsorbable screws or metallic screws.
6) The knee is checked for stability and the surgeon carries out any other repairs.