Table 1.

Step-by-Step Nonanatomic PMB Augmentation of the PCL After Hyperextension Trauma

Step	Description
1	The patient is placed supine on the operating table with the operated limb positioned in a leg-holder at 90° of knee flexion. A tourniquet is placed on the proximal thigh.
2	A standard AL arthroscopic portal is created to explore the joint. Through direct visualization, the best position for the AM is decided.
3	A standard PM viewing portal is established with transillumination to visualize and avoid iatrogenic injuries to the saphenous vein and nerve. A switching stick is then introduced into the PM portal. The camera can be introduced into the PM viewing portal over the switching rod.
4	With the arthroscope positioned in the high AL portal, the insertion point of the PMB on the femur is identified and marked using radiofrequency to ensure accuracy when the guide pin is passed.
5	The arthroscope is switched to the PM portal, and the tibial PMB footprint is identified using a radiofrequency ablation device. The PCL tibial tunnel drill-guide is inserted through the AM portal and placed close to the native PMB footprint.
6	A 2.4-mm guide pin is inserted carefully to avoid damaging the posterior neurovascular structures, and an outside-in tibial tunnel of 6 or 7 mm that matches the graft diameter is drilled with a cannulated reamer under direct visualization.
7	A looped nonabsorbable suture is inserted into the tibial tunnel using a suture passer and retrieved from the AM portal with a KingFisher grasper.
8	The arthroscope is switched to the high AL portal and a femoral 2.4-mm guide pin is introduced through an accessory inferolateral portal and drilled, with a free-hand technique, across the medial femoral condyle and the skin.
9	A 6- to 7-mm inside-out femoral socket is reamed and a shuttle looped nonabsorbable suture is passed out of the thigh and retrieved from the AM portal with a KingFisher grasper.
10	The tibial and femoral shuttle suture are tied together and pulled through the tibial tunnel. The tie is opened and the tibial suture is removed, leaving only the femoral shuttle suture through both femoral and tibial tunnel.
11	The graft is inserted from the tibia to the femur and first fixed on the femoral side with a bioabsorbable interference screw. The graft is then secured on the tibial side with a bioabsorbable interference screw in full extension and neutral rotation, after applying an anterior drawer.

AL, anterolateral; AM, anteromedial; PCL, posterior cruciate ligament; PM, posteromedial; PMB, posteromedial bundle.