Table 2.

Repair of PCL Peel-Off Avulsion From Femoral Condyle Using 2 Knotless Anchors

Indications

PCL soft-tissue avulsion from femoral footprint (proximal fibers)

Adequate PCL tissue length to restore ligament to its footprint

Adequate tissue quality to hold sutures

Patients in whom PCL reconstruction cannot be performed  (e.g., associated tibial plateau fracture)

Patients with multiligament injuries that will require concurrent  repair or reconstruction of other ligaments

Young patients with open physes

Contraindications

Bony avulsion

PCL midsubstance injuries

Inadequate tissue/bone quality

Tips

Good view of footprint from lateral parapatellar portal

Ability to mobilize PCL to ensure reducibility to its footprint

Use of PassPort cannula to easily place knotless anchors

Performance of microfracture on footprint to improve  ligament-bone healing

Use of sutures in figure-of-8 fashion to ensure good purchase of  ligament

Pearls

Repairing the PCL reduces the morbidity associated with  reconstruction. It has been shown that there is no statistical  difference in strength or stiffness for a suture anchor and  knotless anchor construct compared with a bone tunnel  construct for an anatomic repair.10

The most important aspect is to place the anchors at the anterior  edge of the footprint so that the ligament will reduce and place  tension on the repair.

Reduction of the joint by the anterior drawer maneuver should be  performed when reducing the ligament by anchor insertion.

Pitfalls

A divergence between the knotless suture anchor insertion and  the drilled hole can damage the anchor.

Insufficiently tensioning the ligament or not performing an  anterior drawer maneuver during the insertion of the anchors  may cause failure of the operation.

Key points

Place the lateral parapatellar portal while ensuring placement in  the correct direction to grab the PCL and to position the anchors.

Place a cannula into the lateral parapatellar portal to easily access  the PCL and avoid positioning of the sutures into the fat pad.

Perform microfracture to obtain bleeding from the bone to  improve ligamentous healing.

Pass each suture through the tissue twice to obtain a locking  figure-of-8 construct to obtain good purchase of the ligament.

Place the anchor holes at the anterior border of the footprint to  help reduce and tension the PCL to its footprint.

Carefully tension the ligament before the final seating of the  anchors, and perform an anterior drawer maneuver while  inserting the anchors into the predrilled holes.