The double femoral tunnel technique for arthroscopic reconstruction of the posterior cruciate ligament with the semitendinosus and gracilis autograft

This article describes the technique of the single-incision arthroscopic method for posterior cruciate ligament (PCL) reconstruction with doubled semitendinosus and gracilis autograft. This technique is indicated for chronic lesions with a posterior drawer of more than 10 mm compared with the contralateral knee. The steps are (1) diagnosis and treatment of associated lesions; (2) harvesting of tendon grafts; (3) removal of the PCL stump; (4) reconstruction of the PCL [(a) tibial tunnel with a guide at 55 degrees, (b) double femoral tunnels]; and (5) insertion and fixation of the grafts. The position of the posteromedial femoral tunnel is at 8 mm from the anterior femoral cartilage, and the anterolateral tunnel is at 13 mm. The salient feature of this technique is the fixation of the posteromedial and the anterolateral bundle in extension and flexion, respectively. A severe peripheral instability (usually posterolateral) requires the reconstruction of this portion before the intra-articular treatment. The postoperative management is slow, with the recovery of the full range of motion in 45 days.