Table 4.

Pearls and Pitfalls of Anatomic Double-Bundle PCL Reconstruction

Surgical Pearls	Surgical Pitfalls
Allow for full flexion and extension of the knee when positioning the patient Femoral tunnel convergence can occur because of failing to create divergent tunnels Use an arthroscopic coagulator to outline the distal location of each bundle for more accurate tunnel placement Making the tibial tunnel too anterior can lead to iatrogenic meniscal root tears Acorn reamers are recommended so adjustments can be made to the tunnel path Extreme diligence must be taken while reaming the tibial tunnel. Finish reaming by hand and position a curette above the pin when reaming to avoid neurovascular complications The ALB should be fixed first with the knee at 90o flexion, then the PMB should be fixed second with the knee at 0o Incorrect knee flexion angles during fixation may lead to initial graft over-constraint and subsequent laxity during motion

PCL – posterior cruciate ligament; ALB – anterolateral bundle; PMB – posterolateral bundle