Bicruciate (anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL)) lesions are rare, usually are caused by closed knee dislocations, and often are associated with peripheral injuries. The result of combinated anterior and posterior cruciate ligament lesions is a painful and debilitating knee instability that involves a discomfort for the patient, not only in sports but also in daily activities.
Surgical treatment of ACL/PCL lesions is necessary to restore knee kinematics, and early arthroscopically assisted reconstruction has been recommended to recreate a correct central vertical rotation axis.
In the orthopedic literature, surgical treatments of combined ACL/PCL tears are different in timing, techniques, and graft choice.
The purpose of this chapter is to illustrate our preferred approach for bicruciate lesions that consist in a full arthroscopic, single-bundle (pro anterolateral bundle) PCL reconstruction and single-bundle anatomical ACL reconstruction.
This is a preview of subscription content, log in to check access.
Kannus P, Bergefeld J, Jarvinen M, Johnson RJ, Pope M, Renstrom P, et al. Injuries to the posterior cruciate ligament of the knee. Sports Med. 1991;12:10–131.CrossRefGoogle Scholar
Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A. Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow up results. Knee Surg Sports Traumatol Arthrosc. 2006;14:739–49.CrossRefGoogle Scholar
Bowman KF Jr, Sekiya JK. Anatomy and biomechanics of the posterior cruciate ligament, medial and lateral sides of the knee. Sports Med Arthrosc. 2010;18:222–9.CrossRefGoogle Scholar
Fanelli GC, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy. 2002;18:703–14.CrossRefGoogle Scholar
Stayner LR, Coen MJ. Historic perspectives of treatment algorithms in knee dislocation. Clin Sports Med. 2000;19:399–413.CrossRefGoogle Scholar
Ohkoshi Y, Nagasaki S, Shibata N, Yamamoto K, Hashimoto T, Yamane S. Two-stage reconstruction with autografts for knee dislocations. Clin Orthop. 2002;398:169–75.CrossRefGoogle Scholar
Schenck RC Jr, Robert C. Management of posterior cruciate ligament injuries in knee dislocation. Oper Tech Sports Med. 1993;1:143–7.CrossRefGoogle Scholar
Wen-Lin Y, Yuan-Kun T, Juin-Yih S, Wen-Wei HR. Knee dislocation: treatment of high-velocity knee dislocation. J Trauma. 1999;46:693–701.CrossRefGoogle Scholar
Wascher DC, Blevins FT, Robinson B. Timing of surgical treatment of the dislocated knee. Arthroscopy. 1999;15:S43.Google Scholar
Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med. 1995;23:580–7.CrossRefGoogle Scholar
Mariani PP, Margheritini F, Camillieri G. One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction. Arthroscopy. 2001;17:700–7.CrossRefGoogle Scholar
Margheritini F, Mancini L, Mauro CS, Mariani PP. Stress radiography for quantifying posterior cruciate ligament deficiency. Arthroscopy. 2003;19:706–11.CrossRefGoogle Scholar
Mariani PP, Adriani E, Santori N, Maresca G. Arthroscopic-assisted posterior cruciate ligament reconstruction using patellar tendon autograft: a technique for graft passage. Arthroscopy. 1996;12:510–2.CrossRefGoogle Scholar
Margheritini F, Rihn JA, Mauro CS, et al. Biomechanics of initial tibial fixation in posterior cruciate ligament reconstruction. Arthroscopy. 2005;21:1164–71.CrossRefGoogle Scholar