TREATMENT OF POSTERIOR AND POSTERIOR-POST EROLATERAL KNEE INSTABILITY

The natural course after posterior cruciate ligament (PCL) tear is a s low process of degeneration starting in the medial compartment. Functi onal disability is mainly present in those instabilities that are comb ined with posterolateral insufficiency. The surgical treatment at pres ent mainly addresses these combined types of posterior-posterolateral instability. It is generally agreed that suture of the torn PCL alone is insufficient and augmentation with autologous structures, such as t he patellar ligament, are mandatory. Synthetic augmentation to facilit ate after treatment is another adjunct. Because of the difficulty of p recise tibial tunnel placement a two-stage procedure is advocated, an anterior approach with the patient supine being used for femoral graft placement. If a posterior approach with the patient prone is used, a straight posterior incision is made between the two heads of the gastr ocnemius and the neuromuscular bundle. With this approach the tibial b one block is placed in a trough. The accuracy of graft placement and t he immediate functional after treatment facilitated by the use of osse ous fixation of a synthetic augmentation device at both ends have made better results of surgical reconstruction of the PCL possible.