All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique  Matthew R. Prince, D.O., Michael J. Stuart, M.D., Alexander H. King, B.S., Paul L. Sousa, M.B.A., Bruce A. Levy, M.D.  Arthroscopy Techniques  Volume 4, Issue 5, Pages e619-e624 (October 2015) DOI: 10.1016/j.eats.2015.06.009 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 New anatomic contoured posterior cruciate ligament (PCL) guide. The guide is set to 60° to avoid the killer turn. The guide hugs the anatomic contour of the PCL facet, as shown in the inset. The arrow highlights the medial and lateral cutouts for the mammillary bodies, along with the broad design, acting as a neurovascular shield during drilling. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Top-down view of anatomic contoured posterior cruciate ligament (PCL) guide. Twisting (arrow) allows maneuverability around the anterior cruciate ligament and proper positioning 1 cm from the tibia crest anteriorly. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Intraoperative fluoroscopic views of (A) 2.4-mm guide pin placement (arrow) and (B) 3.5-mm FlipCutter (arrow) during all-inside posterior cruciate ligament (PCL) reconstruction. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 View from anteromedial portal showing guide pin placement (arrow) in center of anterolateral bundle fibers. One should note the importance of the vertical orientation and proximity to the medial femoral condyle articular cartilage margin. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 Graft preparation using a quadruple-bundled tibialis anterior, approximately 90 mm long and 10 to 12 mm thick. Two loop stitches are placed on each end of the graft (arrow); the surgeon ensures that all 4 strands are captured by passing the suture from inside out and then outside in. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 6 Postoperative radiographs of a posterior cruciate ligament–fibular collateral ligament/posterolateral corner (FCL/PLC) reconstruction showing an all-inside arthroscopic approach using a quadrupled tibialis anterior allograft with both tibial and femoral suspensory fixation and a specialized tibial guide that allows for safe anatomic tibial tunnel placement. Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 7 (A) Passing of tibial TightRope ABS with passing suture cinched onto loop (arrow). (B) Close-up view of passing suture cinched onto loop (arrow). (C) Bringing graft into tibia first. (D) ABS button (arrow) used at end of procedure. (Figure courtesy of Arthrex.) Arthroscopy Techniques 2015 4, e619-e624DOI: (10.1016/j.eats.2015.06.009) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions