Tunnelless Posterior Cruciate Ligament (PCL) Reconstruction is a technique Dr. Chudik is developing to reconstruct the PCL without drilling large tunnels in the bones of the femur and tibia. The goal is to use a less invasive procedure that better reproduces the normal anatomy and function of the PCL.
Dr. Chudik has successfully performed tunnelless PCL surgery on the tibial side. Further development is still needed to address the femoral side.
What Is Tunnelless PCL Reconstruction?
The posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. It is a rope-like structure that helps maintain the normal relationship between the femur (thigh bone) and tibia (shin bone), preventing the tibia from sliding backward relative to the femur.
The PCL is the largest and strongest ligament within the knee. When torn, it may heal in a lengthened or stretched-out position, or it may attach to other structures of the knee through scar tissue.
Dr. Chudik is developing a less invasive tunnelless PCL reconstruction technique that reconstructs the ligament without drilling large tunnels in the femur and tibia. The graft is aligned and secured in its anatomic position with special fixation devices.
Development Rationale
Dr. Chudik is developing tunnelless PCL surgery as a less invasive way to reconstruct the ligament while better reproducing the normal anatomy and function of the PCL.
He has successfully performed tunnelless PCL surgery on the tibial side. Additional development is still needed to address the femoral side.
Who Is a Candidate?
An isolated PCL tear can often be treated without surgery. PCL reconstruction may be indicated when pain and instability continue despite non-surgical treatment or when other knee ligaments are also damaged.
Patients who are unable or unwilling to complete the required postoperative rehabilitation program should not have surgery.
A current or previous knee infection is a concern, although it is not an absolute contraindication. Severe knee arthritis is also a contraindication to surgery.
How the Procedure Is Performed
PCL reconstruction can be performed as an outpatient procedure, allowing the patient to go home the same day. General anesthesia and an adductor and IPACK block may be used.
The torn PCL is replaced with a graft that is aligned and secured in its anatomic position with special fixation devices.
There are different PCL graft options, each with its own risks and benefits. Before surgery, Dr. Chudik discusses the graft options and determines which is appropriate for the individual patient.
Dr. Chudik’s developing tunnelless technique reconstructs the PCL without drilling large tunnels in the femur and tibia. He has successfully performed this technique on the tibial side, while further development is still needed for the femoral side.
Recovery and Rehabilitation
Following an isolated PCL reconstruction:
- Crutches and non-weight bearing are required for approximately six weeks
- A hinged knee brace is worn for four weeks with the knee locked straight, followed by gradually increasing motion for a total brace time of eight weeks
- The wound should be kept clean and dry for the first 10 to 14 days
- Light showering is allowed after two weeks, but the wounds should not be submerged in water for three weeks
- Driving may resume after six weeks when the right leg is involved
- Return to school or sedentary work may occur in less than one week as long as the leg can be elevated and the patient can use crutches
- Physical therapy to restore motion, strength, and proprioception (balance) may continue for four to six months
After the knee is fully rehabilitated, Dr. Chudik performs PCL Return to Sport Testing to determine whether rehabilitation is complete and whether movement patterns known to increase the risk of knee injury have been corrected before returning to activities.
Minimal daily walking and regular daily activities may resume once the patient is off crutches, approximately six weeks after surgery. Return to running may occur at about four to six months, with return to sports at approximately six months.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Nerve injury resulting in numbness around the knee; small areas of temporary or permanent numbness around the incisions are not uncommon
- Postoperative infection that may require removal of the graft
- Re-rupture or stretching of the reconstructed ligament, resulting in recurrent instability
- Knee stiffness requiring prolonged rehabilitation or repeat surgery
- Rare pain from the fixation device used to hold the graft
- Rarely, a blood clot in the veins of the calf or thigh that may travel to the lungs
Why Dr. Chudik for Tunnelless PCL Reconstruction
Dr. Chudik is developing a less invasive tunnelless PCL reconstruction technique designed to reconstruct the ligament without drilling large tunnels in the femur and tibia and to better reproduce the normal anatomy and function of the PCL.
He has successfully performed tunnelless PCL surgery on the tibial side and continues development of the technique for the femoral side. Before surgery, Dr. Chudik also discusses the available graft options and determines the appropriate graft for each patient.