Posterior cruciate ligament reconstruction using autogenous central quadriceps tendon

As with many other arthroscopic procedures, arthroscopically assisted reconstruction of the posterior cruciate ligament (PCL) is a procedure in evolution. Many techniques require an incision over the medial femoral condyle for creation of an outside-in femoral tunnel. This dissection may cause injury to the vastus medialis obliquus (VMO) and slow the recovery of the quadriceps function. The ideal graft for this procedure causes minimal harvest morbidity, has strength equal to native PCL, allows aperture fixation at normal attachments sites, rapidly incorporates into the bone tunnels, is amenable to passage within the small confines of the knee joint, and reproduces normal kinematic loading within the knee joint. Our current graft of choice is an autogenous central third quadriceps tendon graft, which has a soft-tissue collagen component much larger than that of the patellar tendon. This graft has acceptable harvest morbidity and provides both a bony end and a tendinous end for easier passage within the knee joint. We present a technique for arthroscopically assisted PCL reconstruction in which the femoral tunnel is made with an inside-out technique. This minimizes injury to the VMO and also removes less bone from the medial femoral condyle, potentially reducing the risks of fracture and avascular necrosis risks. Additionally, aperture fixation of the graft allows for increased mechanical properties at time zero.