PCL Reconstruction Using Adjustable Buttons with Outside-In Tunnel for Tibial Fixation: A case report

Introduction: Posterior cruciate ligament (PCL) reconstruction needs a large and long graft. An allograft is a preferable option for thicker graft but its availability is limited in Indonesia. Alternatively, autograft needs to be folded several times for sufficient thickness but it will be shorter and only applicable for the inside-out method. We present a case of PCL reconstruction using a double adjustable button fixation with the outside-in tibia tunneling method. Case Presentation: A fifty-five-year-old male came to our office with an unstable right knee after he fell 1 month ago. Physical examination showed positive posterior drawer and mild right knee effusion, other findings were normal. MRI revealed a total PCL rupture. Two weeks later, the PCL reconstruction was done using autograft from gracillis and semitendinous. A large adjustable button was placed on the tibia tunnel, using the outside-in technique. Knee was stable postoperatively. Discussion: PCL reconstruction using double adjustable buttons was chosen to accommodate larger but shorter autografts. The outside-in tibial tunnel has less risk of graft laxity less expensive and more simple technically compared to inside-out adjustable button tunnel. Conclusion: Tibial fixation using an adjustable large button should be considered in PCL reconstruction with short autograft.