title: Surgical technique: when to arthroscopically repair the torn posterior cruciate ligament.
abstract: BACKGROUND
  Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2-3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.
  
  
  METHODS
  As part of a reconstruction/repair of a multiligament-injured knee, we performed arthroscopic primary repair of the posterior cruciate ligament by passing Bunnell-type stitches into the substance of the ligament using a reloadable suture passer. We then passed the sutures through drill holes into the femoral footprint of the ligament and tied them over a bony bridge.
  
  
  METHODS
  We retrospectively reviewed three patients with posterior cruciate ligament tears associated with a multiligament-injured knee. All patients had posterior cruciate ligament soft tissue avulsions or "peel off" injuries diagnosed by MRI. The described repair technique was used to repair the posterior cruciate ligament avulsion. Minimum followup was 64 months (mean, 68 months; range, 64-75 months). ROM, stability testing, and functional outcome scores (Lysholm and modified Cincinnati) were recorded.
  
  
  RESULTS
  Mean ROM was 0° to 127°. Posterior drawer testing was negative in all three patients. The mean Lysholm score was 92 and the mean modified Cincinnati score was 94. Followup MRI confirmed ligament healing in all patients.
  
  
  CONCLUSIONS
  We believe arthroscopic posterior cruciate ligament repair for soft tissue peel off injuries is a technique that, when applied to carefully selected patients, may be helpful to the surgeon treating patients with a multiligament-injured knee.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: Weill Cornell College of Medicine and Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. difeliceg@hss.edu
authors: Gregory S
authors: GS
authors: Difelice
authors: Micah
authors: M
authors: Lissy
authors: Paul
authors: P
authors: Haynes
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012421:Rupture; D013536:Suture Techniques