POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTIO N AND BICEPS TENODESIS AFTER CLANCY - TECHNIQUE AND RESULTS

Operative treatment of chronic combined posterior/posterolateral knee instability is difficult. If the osseous anatomy of the leg causes a v arus loading of the knee, we perform a high tibial valgus osteotomy as first step. Since 1988 we have been using a special drill guide syste m for reconstruction of the posterior cruciate ligament. The tunnels a re drilled with the instruments placed through the notch and with imag e intensifier control. We prefer a bone-tendon-bone-patellar tendon au tograft or allograft for replacement of the posterior cruciate ligamen t. The procedure is combined with a biceps tenodesis as described by C lancy. Rerouting of the biceps tendon over the origin of the lateral c ollateral ligament puts tension on the posterolateral corner and augme nts the collateral ligament. It was possible to review 16 out of 18 ca ses treated in this way at an average of 18 months after surgery. Preo peratively, all had a 2 to 3+ posterior drawer and a reversed pivot sh ift. At follow-up, 10 had a 1+ posterior drawer, 3 a 1-2+ drawer and 3 a 2+ drawer; 5 patients still had a reversed shift. KT-1000 measureme nts revealed 8 mm (4-12 mm) posterior translation. The Lysholm Score a veraged 83 points and the Tegner Score 4.0 at follow-up.