Abstract
INTRODUCTION: PCL tears comprise 3% of outpatient knee injuries. The treatment of complete PCL ruptures remains controversial. Single bundle transtibial PCL reconstruction is the common technique for restoring this ligament. However, this procedure is technically demanding and complications can occur if poor techniques are used. This prospective case reported single-bundle transtibial PCL reconstruction in total PCR rupture and analyzed the potential pitfalls of this procedure. CASE REPORT: A 21-years-old male patient with chief complaints were pain and instability on his right knee. Clinical examinations, knee radiograph, and MRI revealed a total PCL rupture on the right knee. The patient then underwent an arthroscopic surgical reconstruction for PCL using single-bundle transtibial technique. The graft tissue was harvested from he semitendinosus and gracillis tendons. A standard arthroscopic examination of the joint was carried out, using a low anterolateral and a high-antero-medial portal. The tibial tunnel was drilled from a lateral start point. The femoral tunnel was created using outside-in technique. Afterward, a looped wire was placed from the tibial tunnel out of the femoral canal to allow/ easy graft passage. Fixations were caried out using bio screw. A favorable outcomes were noted following PCL reconstruction surgery. There were negative posterior drawer test, posterior sag sign, and full range of motion in the patient. DSICUSSION: There are many pitfalls in each steps of the procedure. The graft choice remains controversial because no ideal graft exists to replace this large ligament. The failure of using arthroscope can lead to poor placement of the portal in this reconstruction. In creating the tibial tunnel, poor technique and inadequate visualization can place the popliteal artery at risk. The comparison of creating femoral tunnel with outside-in or inside-out manner remains unclear. The graft passage is the most challenging apsect of this procedure becase o the sharp angle the graft must transverse after exiting the tibial tunnel, and the fixation can be inadequate due to different direction of bone tunnels. CONCLUSION: Single-bundle transtibial PCL reconstruction is a technique for restoring this ligament with good results. However, this procedure is technically demanding, and complications can occur if poor techniques are used. There are many potential pitfalls in each steps of this procedure. Future studies that may ease the technical demands and reduce the risk of avoidable complications of this technique are highly need.