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Presenters debate need for posterior portals in safe PCL reconstruction
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At the European Society for Sports Traumatology, Knee Surgery and Arthroscopy Congress, presenters debated whether portals are needed for a safe arthroscopic PCL reconstruction.
Rodolphe Limozin, MD, said portals are not necessary to have a safe arthroscopic PCL reconstruction and said the anterior portal approach is sufficient for safe PCL reconstruction.
“[We] think it is possible to avoid the posterior portal during this surgery, but you have to keep the fluoroscopy in control and you need a specific ancillary and you have to be able to perform a posteromedial portal in case of necessity,” he said. “You have to keep the fluoroscopy in control during surgery because of security and gain of time because it gives directly good position for tibial aiming.”
Limozin noted he has performed more than 200 PCL surgeries since January 2011 and has only needed to perform five PCL surgeries using the posteromedial portal approach for exposition and tibial aiming and to have debridement by the posteromedial portal.
During his presentation, Bertrand Sonnery-Cottet, MD, said the posteromedial portal approach is needed to have a safe PCL reconstruction. The reason PCL reconstructions are unsafe is due to the proximity of the artery to the tibial tunnel, he said.
“Arthroscopic PCL reconstruction was less invasive, [with] better clinical results and better range of motion,” Sonnery-Cottet, said. “We moved from open approach to arthroscopic approach ... The arthroscope allows [us] to have control of [the] tibial tunnel. PCL reconstruction needs to have three controls.”
He noted the posteromedial portal allows perfect control of the tibial tunnel, direct vision of the nail, allows for control of the jig of the PCL and good control of the imaging.
“[The] PCL reconstruction is still difficult, but mostly a dangerous procedure. [The] artery is close to tunnel. You need to control that but if you perform your reconstruction with a posteromedial portal, you have a perfect control of tunnel,” Sonnery-Cottet, said. “It is safe, both predictable and efficient, and particularly safe and secure when you combine [it] with fluoroscopy. – by Monica Jaramillo
Reference:
Barth J, et al. Debate arthroscopic PCL reconstruction: How many and what portals are needed for a safe reconstruction. Presented at: European Society for Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 9-12, 2018; Glasgow, United Kingdom.
Disclosures : Limozin and Sonnery-Cottet report no relevant financial disclosures.