How is PCL reconstruction surgery done?

Graft options

• Hamstring tendons or the quadriceps tendon from your own leg
• The patellar tendon with small bone blocks, in some cases
• A donor graft, often chosen when several ligaments are reconstructed at once, to avoid taking multiple tendons from an injured leg

The PCL is a large ligament, so the graft needs to be thick enough. Dr. Gelber discusses the options and their trade-offs before surgery.

The main steps

Through small arthroscopy incisions, the inside of the knee is examined and any meniscus or cartilage problems are treated. A tunnel is drilled in the femur at the PCL's original attachment and another in the back of the tibia. Because the tibial tunnel is close to the main artery behind the knee, this step is done with specific instruments, guides and imaging to keep it safe.

The graft is passed through the tunnels and fixed with screws or buttons while the shin is held in its correct forward position. Some surgeons reconstruct one bundle of the ligament, others two. Both approaches are used, and the choice depends on the injury and the surgeon's experience.

Fixing a bony avulsion

In some injuries the PCL itself is intact but has pulled off the bone where it attaches to the back of the tibia. When the fragment is large enough, it can be fixed back with a screw or sutures, either through a small incision at the back of the knee or arthroscopically. Healing is bone to bone, which often gives a good result.

Combined procedures and the hospital stay

If the posterolateral corner, medial ligament or ACL is also torn, these are usually reconstructed in the same operation. Surgery is performed under general or spinal anaesthesia, often with a nerve block. Many patients stay one or more nights at Aman Hospital, and leave with crutches and a PCL brace that supports the back of the shin.