PCL Reconstruction: Fixation Techniques



- Post Fixation:
    - w/ BPB grafts, the sutures are passed thru the bone plug and then are passed around a screw over a washer;
    - w/ soft tissue grafts (such as tendinous edge of Achilles tendon graft), requires a Krackow stitch (whiped locking stitch) is required;

- Spiked Washer Fixation:
    - allows secure fixation of soft tissue w/o necrosing tissue;
    - a whipped locking stitch is inserted into the tendon end, and is tied around the screw prior to final tightening of the screw;

- Button Fixation:
    - sutures are passed thru a ligament button and tied under tension;
    - the suture ends are then passed under a staple to prevent excess motion while the graft material heals into the tunnel surface;

- Interference Screw Fixation:
    - may provide most stable fixation;
    - interference screw threads may cut into bone plug sutures, especially when they the screw comes into the cortical surface of the bone plug;
    - screw threads may cut into tendinous portion of the graft if it is advanced too far into the tibial tunnel;

- Staple Fixation:
    - may cause pressure necrosis and early graft failure;
    - prior to stapling a trough should be cut into the underlying bone



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 31, 2011 3:22 pm