An accessory portal for posterior cruciate ligament tibial insertion visualization

Posterior cruciate ligament (PCL) reconstruction is infrequently performed, technically challenging, and has less predictable results compared with its anterior cruciate ligament (ACL) counterpart. Creation of a transtibial tunnel has been associated with catastrophic neurovascular complications, as well as tunnel malpositioning. This technical note reports the use of the femoral PCL tunnel to visually access the posterior slope for tibial tunnel creation. This technique modification allows concurrent placement of instruments through an inferomedial and/or posteromedial portal to facilitate PCL insertional debridement, placement of the tibial aimer, and creation of the tunnel. We feel that this technical modification provides superior visualization of this anatomic area.