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Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech Volume 2(1):e1 January 11, 2012 ©2012 by The Journal of Bone and Joint Surgery, Inc.

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Page 1: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic

Femoral Graft Placement

by Robert F. LaPrade, and Casey M. Pierce

JBJS Essent Surg TechVolume 2(1):e1

January 11, 2012

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Arthroscopic image showing the “slack” ACL (yellow arrow) due to the loss of support from the torn PCL.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Arthroscopic image showing a coagulator marking the PCL bundle attachment sites on the femur.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Arthroscopic image showing the “shiny white fibers” of the posterior horn of the medial meniscus (yellow arrow).

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Intraoperative photograph showing proper placement of the tibial guide prior to drilling of the guidepin.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Fig. 5-A Intraoperative photograph showing proper placement of the tibial guidepin at approximately a 45° angle to the tibial shaft or diaphysis.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 17: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Intraoperative anteroposterior fluoroscopic view (Fig. 6-A) and lateral fluoroscopic view (Fig. 6-B) demonstrating the proper position for the tibial tunnel guidepin and the “champagne-glass drop-

off” (yellow line).

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 18: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Arthroscopic image showing the proper location of the femoral tunnels viewed through the anterolateral portal.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 19: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Intraoperative photograph showing the femoral bundle grafts.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 20: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Intraoperative photographs showing the PCL reconstruction grafts before they are passed through the tibial tunnel (Fig. 9-A) and the proper position after they are passed through the tibial

tunnel (Fig. 9-B).

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.

Page 21: Double-Bundle Posterior Cruciate Ligament Reconstruction Technique with Use of Endoscopic Femoral Graft Placement by Robert F. LaPrade, and Casey M. Pierce

Intraoperative photographs showing fixation of the reconstruction bundle grafts to the tibia with use of surgical staples.

Robert F. LaPrade, and Casey M. Pierce JBJS Essent Surg Tech 2012;2:e1

©2012 by The Journal of Bone and Joint Surgery, Inc.


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