Revision PCL Reconstruction Review/Update

Purpose of Review

The primary goal of this review is to update recent literature on revision PCL reconstruction and to discuss factors relevant to surgical failure, surgical indications and goals, patient evaluation, surgical decision-making, graft selection, surgical technique, associated surgical procedures, postoperative rehabilitation, and revision PCL reconstruction results.

Recent Findings

Specifically, it is paramount to consider and treat posteromedial and posterolateral instability. Success in revision surgery focuses on appropriate graft choice and precise tunnel placement at anatomical attachment sites. Furthermore, correct tensioning of the graft, secondary or backup fixation and well-designed PT and rehab protocols are integral components. The factors causing failure of the primary reconstruction should be identified, as revision surgery must address the errors and follow strict surgical principals to be successful.

Summary

There are many variables that play a role in successful revision posterior cruciate ligament (PCL) reconstruction. In general, as in most ligament reconstruction surgery, it is important to identify and address all associated pathology such as lower extremity malalignment and additional instability.