All-Anterior Approach for Arthroscopic Posterior Cruciate Ligament Reconstruction With Remnant Preservation Tianwu Chen, M.D., Shaohua Liu, M.D., Jiwu.

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All-Anterior Approach for Arthroscopic Posterior Cruciate Ligament Reconstruction With Remnant Preservation Tianwu Chen, M.D., Shaohua Liu, M.D., Jiwu Chen, M.D., Ph.D. Arthroscopy Techniques Volume 5, Issue 6, Pages e1203-e1207 (December 2016) DOI: 10.1016/j.eats.2016.07.011 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 An anterior tibialis tendon allograft is doubled and linked to the selected Endobutton CL (Smith & Nephew). The open end of the graft is baseball-stitched using No. 4843 suture for traction. The prepared graft is approximately 12-13 cm in length and 8-9 mm in diameter. Arthroscopy Techniques 2016 5, e1203-e1207DOI: (10.1016/j.eats.2016.07.011) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 View from the anterolateral portal showing guide pin placement (arrow) between the anterolateral and posteromedial bundle of the native posterior cruciate ligament via the inferior anterolateral portal. This femoral point is approximately 11 o'clock at the left knee and 1 o'clock at the right knee. Arthroscopy Techniques 2016 5, e1203-e1207DOI: (10.1016/j.eats.2016.07.011) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Side view of the posterior cruciate ligament (PCL) tibial guide. The guide is set to 50 and crosses over the killer turn, and then reaches the PCL insertion area. The arrow emphasizes the groove at the terminal side of the tool. The groove is designed to protect neurovascular structures by confining the pin drilled through the tibial tunnel. (B) View of the anatomically contoured PCL guide, which is inserted through the anteromedial portal. Arthroscopy Techniques 2016 5, e1203-e1207DOI: (10.1016/j.eats.2016.07.011) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) A piece of steel wire is folded and axially twisted. The arrow highlights a drop-of-water-like loop (arrow) at the folded side. (B) Side view of the posterior cruciate ligament elevator and wire catcher (PEWC). The articular portion of the tool is anatomically contoured for tibial plateau and killer turn. A cubical pit (arrow) is set in the terminal enlargement side. (C) Top-down view of the PEWC. The enlarged terminal side shields the posterior neurovascular structures by retarding the drill bit in tibial tunnel preparation. (D, E) The head of the self-made wire could stably residue in the pit from difference view angles. Arthroscopy Techniques 2016 5, e1203-e1207DOI: (10.1016/j.eats.2016.07.011) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Postoperative (A) anteroposterior and (B) lateral radiographs of a posterior cruciate ligament reconstruction of the right knee showing an all-anterior arthroscopic approach using a double anterior tibialis allograft with femoral suspensory fixation and tibial interference screw fixation. Arthroscopy Techniques 2016 5, e1203-e1207DOI: (10.1016/j.eats.2016.07.011) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions