All-arthroscopic treatment of combined PCL and PLC instability using the trans-septal approach is shown in a right knee in the supine position.
|Trans-septal approach||Posterolateral and posteromedial portals should be well established.|
Shaver faces toward the scope (anterior) in order to avoid any popliteal neurovascular bundle injury
The PCL tibial attachment exposure can be completely achieved by detaching the posterior capsule from the PCL for more than 10 mm downward from the articular surface.
In addition to a direct visualization, a fluoroscopic examination is recommended to confirm the location of the tip of the guidewire before overdrilling it with a reamer.
|Creating the posterior portals using the light source to transilluminate the skin incision, which avoids neurovascular injury|
Gentle removal of the central-inferior septum is important to avoid iatrogenic injury to the middle genicular vessels.
The retained PCL tibial attachment is useful for setting the orientation of the center of the PCL tibial attachment.
|PCL/ PT tunnel creation||The PCL tibial attachment exposure can be completely achieved by detaching the posterior capsule from the PCL for more than 10 mm downward from the articular surface.||Carefully keep the cutting surface of the shaver in the anteroinferior direction, facing the bone and away from neurovascular bundle.|
|The tension of the ACL provides relatively accurate information about the reduction of the knee joint.||While fixing the PCL graft, maintain the tibia reduced by pulling the proximal tibia anteriorly, while the knee is flexed at 90°.|
|Trans-septal approach is safe and provides direct visualization of the footprints.|
|Less risk of tibial tunnel malpositioning|
|Less exposure and tourniquet time may lead to low infection rates.|
|Significant learning curve in trans-septal approach|
|Risk of vascular injury to the popliteal and the lateral inferior genicular arteries|
|More demanding to identify insertion sites of the posterolateral corner structures arthroscopically than when performing an open procedure|
Trans-septal approach and posterior portals
PCL/ PT tunnel creation
Graft Passage and Fixation
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The authors report the following potential conflicts of interest or sources of funding: Y.L. reports personal fees from Arthrex, Smith & Nephew, Stryker, and Biomet, outside the submitted work. B.S.-C. reports personal fees from Arthrex, outside the submitted work. C.G. reports grants from Arthrex , outside the submitted work. B.A.L. reports grants from Arthrex, outside the submitted work. L.G. reports grants from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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