COMBINED ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT RUPTURE - TECHNIQUEAND RESULTS OF ARTHROSCOPIC ASSISTED RECONSTRUCTION

Simultaneous ACL and PCL ruptures are rare but serious injuries result ing in distinct instability of the knee joint followed by an early deg enerative arthritis. This combined trauma, which is often accompanied by additional ligament lesions, originates from a knee dislocation. Wh ile the conservative treatment of this complex instability is abandone d, the operative procedures are not yet standardised. The timing of th e cruciate ligament reconstruction depends on the additional injuries, but generally the postprimary treatment is performed. Autografts and allografts, which can be also combined, are available for the reconstr uction of the cruciate ligaments. The arthroscopic assisted operation starts with the drilling of all tibial and femoral tunnels using stand ard ACL and PCL arthroscopic instruments. The PCL is positioned after the graft has been transported into the joint through an anterolateral port, the ACL graft is positioned through the tibial drill hole and b oth are anchored first on the femoral and then on the tibial site i.e. with interference screws. In the postoperative rehabilitation neither immobilisation nor brace are used and progressive range of motion is allowed. The arthroscopic assisted reconstructions of the ACL and incr easingly of the PCL are becoming standard procedures, but the technica lly difficult combined ACL/PCL reconstruction is restricted to a small number of arthroscopists. The first clinical results demonstrate, tha t the arthroscopic operation is comparable to the open reconstruction.