Table Of ContentPosterior Cruciate Ligament Injuries
Gregory C. Fanelli, MD
Editor
Posterior Cruciate Ligament
Injuries
A Practical Guide to Management
Second Edition
Editor
Gregory C. Fanelli, MD
GHS Orthopaedics
Danville
Pennsylvania
USA
ISBN 978-3-319-12071-3 ISBN 978-3-319-12072-0 (e-Book)
DOI 10.1007/978-3-319-12072-0
Library of Congress Control Number: 2014960067
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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To my wife Lori, and my children Matthew, David, and Megan who all have a
tireless work ethic, and are a never-ending source of inspiration to me.
v
Preface
Our practice environment largely determines the pathways that our individual orthopedic ca-
reers take. It has been a blessing to be in a position that enabled me to expand my surgical
techniques and research interest in the evaluation and treatment of posterior cruciate ligament
(PCL) injuries and the multiple-ligament-injured knee. I believe the same situation exists for
other contributors to this book. We all share a passion and a commitment to the treatment of
complex knee ligament instabilities. The purpose of this book is to provide experienced knee
surgeons, general orthopedic surgeons, fellows, residents, medical students, and other health
care professionals with an interest in PCL injuries and the PCL-based multiple ligament in-
jured knee, a useful tool for the management of these complex injuries.
Posterior Cruciate Ligament Injuries: A Practical Guide to Management, Second Edition,
is expanded from 19 chapters in the First Edition to 29 chapters in the Second Edition. The
Second Edition is composed of eight functional segments with each segment having a number
of chapters. New topics in the Second Edition include chapters addressing osteotomy, me-
chanical graft tensioning, articular cartilage restoration, meniscus transplantation, new cutting
edge surgical techniques of PCL reconstruction, outcomes data, selected case studies, and the
editor’s 25-year evolutionary experience in the evaluation and treatment of PCL injuries and
the PCL-based multiple-ligament-injured knee. The chapters were organized and written so
that they build upon each other, and also so that they are able to stand alone. This will enable
the reader to leisurely explore the topic of the PCL injured knee, or to use the text as a quick,
practical reference when the need arises.
Chapter 1 presents the editor’s 25-year experience in evaluation and treatment of PCL in-
juries and the PCL-based multiple-ligament injured knee. Chapters 2 and 3 address anatomy
and biomechanics of the knee, while Chaps. 4 through 7 address diagnosis, clinical examina-
tion, instrumented measurement, MRI imaging, and nonsurgical treatment of the PCL injured
knee. Chapters 8 through 20 provide multiple authors’ advanced surgical techniques for PCL
reconstruction. Topics in these chapters include graft selection, arthroscopic PCL primary
repair, arthroscopic PCL reconstruction techniques, tibial inlay PCL reconstruction surgical
techniques, PCL-based multiple knee ligament surgical techniques, PCL reconstruction in pa-
tients 18 years of age and younger, and revision PCL reconstruction.
Chapters 21 through 27 address topics that are often encountered when treating PCL in-
juries. These include mechanical graft tensioning, the role of osteotomy, articular cartilage
restoration, meniscus transplantation, postoperative rehabilitation, functional bracing, and
complications in PCL injuries and reconstruction.
Chapter 28 presents the results of treatment of PCL surgery from an outcomes data per-
spective. The final chapter, 29, presents nine case studies in the management of PCL injuries
and the PCL-based multiple-ligament-injured knee. Each case study presents a different knee
instability problem, and then takes the reader through the decision making process, the surgi-
cal treatment, and the final outcome.
vii
viii Preface
The PCL injured knee and the PCL based multiple ligament injured knee are extremely
complex pathologic entities. I believe that through research, improved surgical techniques, the
use of allograft tissue, advancement in surgical equipment, careful documentation, and experi-
ence, we are progressively improving our outcomes in treating this devastating knee injury.
It is my personal hope that this book will serve as a catalyst for new ideas to further develop
treatment plans and surgical techniques for PCL and related injuries, and that God and His Son
Jesus Christ will continue to guide us in the care and treatment of these patients.
Danville, PA Gregory C. Fanelli, M.D.
Acknowledgements
I want to acknowledge the following people who have directly and indirectly contributed to
this textbook. Connie Walsh (Developmental Editor) at Springer-Verlag, New York for her
help in creating this book. Craig J. Edson, M.S., P.T./A.T.C., friend, colleague, and outstand-
ing clinician and teacher. The Orthopedic Surgery Team at Geisinger Woodbine Lane and
Geisinger Medical Center are the best orthopedic support staff in the world. Their dedication
and drive for excellence are unequaled. To my patients and their referring doctors who have
entrusted their care to me, and to my orthopedic colleagues and friends who have taken time
out of their busy schedules to contribute chapters to this book.
Danville, PA Gregory C. Fanelli, M.D.
ix
Contents
Part I Editor’s Experience
1 Posterior Cruciate Ligament Injuries and Reconstruction:
What I Have Learned ................................................................................................. 3
Gregory C. Fanelli
Part II Anatomy and Biomechanics
2 A natomy and Biomechanics of the Posterior Cruciate Ligament
and Their Surgical Implications ................................................................................ 19
Christopher G. Stevens, Keith Jarbo, Kostas Economopoulos
and Anikar Chhabra
3 A natomy and Biomechanics of the Posterolateral and
Posteromedial Corners of the Knee and Their Surgical Implications ................... 33
Evan W. James, Christopher M. LaPrade, Adam M. Johannsen
and Robert F. LaPrade
Part III Diagnosis and Evaluation
4 Clinical and Arthroscopic Evaluation of the
Posterior-Cruciate-Ligament-Injured Knee ............................................................. 49
Brian M. Devitt and Daniel B. Whelan
5 Instrumented Measurement of the Multiple-Ligament-Injured
Knee: Arthrometry, Stress Radiography, Rotationometry,
and Computer Navigation .......................................................................................... 65
Sasha Carsen, Robert Timothy Deakon and Don Johnson
6 MRI of PCL, Posteromedial, and Posterolateral Corner Injuries of the Knee ..... 75
W. James Malone, Satre Stuelke, Robert R. Snowden
and Joel S. Salesky
Part IV Non-Surgical Treatment
7 Nonoperative Treatment and Natural History
of Posterior Cruciate Ligament Injuries ................................................................... 89
K. Donald Shelbourne
xi
xii Contents
Part V Surgical Treatment
8 G raft Selection in Posterior Cruciate Ligament Surgery...................................... 101
Natalie L. Leong, Nima Kabir and David R. McAllister
9 Arthroscopic Transtibial Tunnel Posterior Cruciate
Ligament Reconstruction .......................................................................................... 111
Gregory C. Fanelli
10 O pen Tibial Inlay Graft for Posterior Cruciate Ligament Reconstruction ......... 123
S. Mark Heard and Meagan Heard
11 All-Arthroscopic Tibial Inlay Double-Bundle Posterior
Cruciate Ligament Reconstruction .......................................................................... 137
Alexander E. Weber and Jon K Sekiya
12 A ll-Inside Posterior Cruciate Ligament Reconstruction ....................................... 147
William M. Engasser, Paul L. Sousa, Michael J. Stuart and Bruce A. Levy
13 T he All-Inside Technique: Surgical Technique and Outcomes ............................. 157
Ranjodh Dhami, Robby S. Sikka, Ryan P. Dunlay and Joel L. Boyd
14 A rthroscopic Primary Repair of Posterior Cruciate Ligament Injuries ............. 165
Dominique D. Nieves, Micah J. Lissy and Gregory S. DiFelice
15 Combined PCL, ACL, Posteromedial, and Posterolateral Reconstruction ......... 173
Gregory C. Fanelli
16 Surgical Treatment of Combined PCL/Lateral-Sided Injuries ............................ 189
Christopher J. Wahl and Paul C. Chin
17 Combined Posterior Cruciate Ligament and Posteromedial Reconstruction ..... 209
Adnan Saithna and Peter B. MacDonald
18 Combined PCL, Posteromedial Corner, and Posterolateral
Corner Reconstruction ............................................................................................. 219
Clayton W. Nuelle and James P. Stannard
19 Posterior Cruciate Ligament Reconstruction in Patients 18 Years
of Age and Younger ................................................................................................... 231
Gregory C. Fanelli and David G. Fanelli
20 Revision Surgery in Posterior Cruciate Ligament Reconstruction ...................... 245
Kevin N. Jiang, Scott R. Kling, Timothy L. Miller
and Christopher D. Harner
Part VI Other Considerations
21 Mechanical Graft Tensioning in Posterior Cruciate
Ligament Reconstruction ......................................................................................... 263
Gregory C. Fanelli
