Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction: Introduction скачать в хорошем качестве

Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction: Introduction

Video 2 of 10 from the JBJS EST article, Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction by Jorge Chahla, MD, Gilbert Moatshe, MD, Lars Engebretsen, MD, PhD, Robert F. LaPrade, MD, PhD. Published February 8, 2017. ➡️ https://bit.ly/3vd3KVi Journal: JBJS Essential Surgical Techniques ➡️ https://jbjs.org/journal.php?j=est Subspecialties: Knee, Sports Medicine The posterior cruciate ligament (PCL) is the main posterior stabilizer of the knee. It is composed of 2 bundles, the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB). The 2 bundles were historically believed to function independently, with the ALB predominantly being an important stabilizer in flexion and the PMB being a stabilizer mainly in extension. However, a recent biomechanical study noted a codominant relationship between these 2 bundles. The anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger ALB, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after a single-bundle reconstruction and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to recreate both bundles using the native footprint, thereby restoring the normal knee kinematics. The anatomic double-bundle PCL reconstruction has demonstrated improved subjective and objective patient outcomes with a low complication rate. Indications for PCL reconstruction are isolated symptomatic acute grade-III PCL tears, combined multiligament lesions, or acute grade-III PCL tears combined with repairable meniscal body or root tears. For chronic PCL tears, indications include functional limitations due to the PCL tear (e.g., difficulty with deceleration, incline descent, or stairs) and comparative PCL stress radiographic laxity of greater than 8 mm in a symptomatic patient. Keywords: JBJS, EST, Essential Surgical Techniques, Key Procedures