Revision of failed-posterior cruciate ligament (PCL) reconstruction due to tibial tunnel misplacement: A case report

Introduction: Posterior cruciate ligament (PCL) reconstruction failure is a rare condition found. The failure caused by some factors, including improper graft tunnel placement. Although the proper tibial tunnel placement in PCL reconstruction is still controversial, make the tunnel placement anatomically essential to decrease the risk of failure. The use of PCL jig only to guide the direction of tibial tunnel does not always give good results. Presentation of case: We report a case of 29 year old male with total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with transseptal portal technique to ensure the tibial tunnel is placed in appropriate position. Discussion: The cause of failure was associated with misposition of tibial tunnel. The tibial tunnel performed in previous surgery was too anterior than the anatomical foot print. This condition might be caused by surgical technique which depending only on PCL jig to guide the tibial tunnel direction and location. We performed transseptal portal technique get better visualization on the posterior aspect of the knee to achieve the proper direction of tibial tunnel. Conclusion: The use of PCL jig as the only tools for guiding tibial tunneling should be avoided. Additional tool such as transseptal portal is required to ensure the proper anatomical tibia tunnel in order to achive good PCL graft placement.