Arthroscopic intercruciate trans-septal posterior cruciate ligament avulsion fixation with pull-through technique using a single button adjustable loop device

Numerous arthroscopic techniques have been described for the fixation of posterior cruciate ligament avulsion, including the pull-out technique with suture or tape fixed with a knot tied over a free cortical button on the anterior tibial cortex, and the adjustable loop with double cortical buttons. We present a modification of the suture pull-out method utilizing the readily available adjustable loop with a single cortical loop button for fixation on the anteromedial tibial cortex. The surgery is performed through an intercruciate trans-septal approach with the suture bridge configuration and cross-over of suture tapes, with two diverging tibial tunnels with a single anterior opening forming a “Y-shaped tunnel.” The advantages of the suture pull-through method and the adjustable loop device can be combined using this technique modification.