Arthroscopy

1. Background

Intact PCL

Anatomy

 

Size

 

2 x as strong as ACL

About the same length as ACL 38 mm

 

Cross sectional area 150% of ACL

13 mm diameter (thicker) 

 

2 Bundles

 

1.  Anterolateral

- most important

- double the size of the posteromedial

- tight in flexion

- try to reconstruct this bundle

Anterior Instability

Epidemiology

 

Traumatic initial cause in 95%

 

M:F 2:1

 

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

 

Anatomy & Stability

 

1. Passive Stabilisers

 

Arthroscopy

Position

 

1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape