Skeletal Radiol (2014) 43:1659–1668

DOI 10.1007/s00256-014-1975-6

REVIEW ARTICLE

Imaging of posterior cruciate ligament (PCL) reconstruction:

normal postsurgical appearance and complications
Andrea Alcalá-Galiano & María Baeva & Maryem Ismael &
María José Argüeso

Received: 24 May 2014 / Revised: 25 June 2014 / Accepted: 28 July 2014 / Published online: 9 August 2014
# ISS 2014

Abstract This article reviews the normal postsurgical anato- experienced significant progress, yet PCL reconstruction re-
my and appearance of PCL reconstructions on MDCT and mains an almost unexplored territory for radiologists, possibly
MRI with the different operative techniques considering the because it is performed less often and there is a lack of
type of tibial fixation, use of a single or double bundle, type of standardization of the surgical techniques [1, 4]. A brief
tendon graft and the fixation material. Tunnel positioning, description of the most widespread surgical techniques for
appearance of the ligament graft and findings at the donor site PCL reconstruction and their normal postsurgical appearance
are considered. Imaging signs of PCL graft failure and its on MDCT and MRI is presented, including findings at the
possible causes are discussed. Imaging manifestations of other donor sites. Signs of graft failure and its possible causes are
potential complications of both the PCL graft and donor sites evaluated, including tunnel placement and other relevant
are described, such as laxity, impingement, arthrofibrosis, parameters, as well as potential complications.
ganglion cyst formation or complications related to the
fixation material.
Surgical techniques
Keywords Posterior cruciate ligament reconstruction .
Ligament plasty . Postsurgical imaging . Postsurgical The indications for PCL reconstruction are: acute PCL lesions
complications . Knee with significant instability (grade 3+), bone avulsion fractures,
combined multiple ligament injuries or chronic symptomatic
PCL laxity [1, 2, 4]. PCL reconstruction techniques have
developed considerably in the last decades, although there is
Introduction
no accepted standard technique [3, 5]. The PCL can be
repaired in isolation or together with other ligaments [3, 7].
Posterior cruciate ligament (PCL) lesions are much less fre-
The native PCL is formed by two bundles, the anterolateral
quent than anterior cruciate ligament (ACL) injuries, and
(AL) and posteromedial (PM), although it could be described
many are partial-thickness tears that can be managed conser-
as a continuity of fibers that rotate during the flexion-
vatively [1–4]. Current knowledge of the impact a PCL defi-
extension cycle of the knee [3]. Knowledge of the insertion
ciency has on the biomechanics of the knee, which may derive
sites of the native PCL in the femur and tibia helps in the
from early osteoarthritis due to chronic instability, and the
positioning of the tunnels for PCL reconstruction (Fig. 1). It is
advances in the surgical techniques have motivated an in-
generally accepted that the optimal positioning of the graft is
crease in the number of surgeries [1–4]. Imaging has also
that which most closely resembles the native PCL [6–8] and
A. Alcalá-Galiano (*) : M. Baeva : M. J. Argüeso
that femoral tunnel placement is more important than the tibial
Department of Radiology, Hospital ASEPEYO Coslada, Madrid, tunnel position [2, 5, 7, 8].
Spain Surgical techniques vary according to [3, 9, 10]:
e-mail: aalcalagaliano@gmail.com
The type of tibial fixation (Fig. 2): tibial inlay or
M. Ismael
Department of Traumatology & Orthopaedic Surgery, Hospital transtibial techniques. In the inlay technique, the graft is
ASEPEYO Coslada, Madrid, Spain directly fixated to the tibia [2, 6, 10] and should
1660 Skeletal Radiol (2014) 43:1659–1668

Fig. 1 Insertion of the native

PCL, showing the AL bundle
(blue) and PL bundle (red)
insertion sites. a Sagittal drawing
of the femur at the intercondylar
notch. b Posterior view of the
tibial plateau. c Sagittal PDI at the
intercondylar notch. d Coronal
T1-weighted image (T1WI) at the
posterior region of the
intercondylar notch

supposedly avoid the so-called killer turn (Fig. 2d), technique reconstructs the more potent AL bundle, but
which occurs at the opening of the tibial tunnel in the does not limit the posterior displacement of the tibia in
transtibial technique [3, 9]. 90° flexion. Hypothetically, the double bundle technique,
The single or double bundle and accordingly the single or which more closely resembles the native PCL, would be
double femoral tunnel (Fig. 3). The single-bundle more effective in controlling posterior stability in flexion,

Fig. 2 Tibial fixation techniques. a Drawing and b sagittal PD MR image of a tibial inlay technique. c Drawing and d sagittal FS PDI of the transtibial
tunnel technique. Note the “killer turn” in the opening of the tibial tunnel (arrowheads), associated with impingement
Skeletal Radiol (2014) 43:1659–1668 1661

Fig. 3 Single- and double-bundle techniques. a MR coronal T2WI and b sagittal PDI in a single-bundle reconstruction. c Coronal T2WI and d sagittal
PDI of a double-bundle reconstruction

but there is no consensus in the literature and it adds Postsurgical imaging

technical difficulties [3, 5, 11].
The type of tendon graft. Bone-tendon-bone (BTB) grafts Radiographs are routinely obtained in the immediate postop-
are generally chosen in young athletes, since they allow a erative period for overview assessment of tunnel placement
quick re-establishment of physical activity [1, 6]. The and the position of the fixation material, but interpretation is
graft is usually harvested from the central third of the variable [6–8]. Postoperative imaging with MRI or MDCT is
patellar tendon along with bone plugs from both inser- generally requested only in symptomatic patients.
tions [1, 2, 6]. Hamstring grafts have several advantages, MRI is the technique of choice in these patients as it
including the absence of complications in the anterior permits an overall evaluation of the PCL reconstruction [8,
region of the knee and the fast regeneration of the tendons 10, 12], including the ligament graft itself, which can only be
[1]. They are usually obtained from the gracilis and evaluated by this technique, although indirect signs of its
semitendinous tendons, harvesting long fibers, which status are reckonable with other modalities. MRI also allows
are folded over, resulting in a graft composed of several appraisal of the tunnels and the surrounding bone, and it
bundles [1, 2]. serves to assess bone and soft tissue complications, including
The fixation material, of which there are two main the donor sites. Tunnel positioning may be checked at a glance
categories with an ample range of options, bone on sagittal images, but all planes have to be reviewed for
plug graft fixation and soft-tissue fixation (metallic precise assessment of tunnel placement and graft status.
or resorbable) [1]. MRI protocols may vary, but as a general rule it is convenient

Fig. 4 MRI in a 32-year-old

patient with double ligament
reconstruction (PCL and ACL)
shows variation of the signal
intensity with the age of the graft.
a Sagittal PD FS 3 months after
surgery shows increased signal
intensity and slight thickening of
the PCL graft (arrowhead). b At
1.5 years after the surgery, nor-
malization of the signal intensity
with hypointensity throughout the
PCL graft is observed (arrow)
1662 Skeletal Radiol (2014) 43:1659–1668

Fig. 5 Graft types on axial PD

FS MRI. a Hamstring graft with
high signal linear intensities
indicating fluid between graft
bundles, a normal finding
(arrowhead). b BTB patellar
tendon graft in a patient with
double cruciate ligament
reconstruction shows
homogeneous low signal intensity
(arrow)

to include at least one T2-weighted sequence (T2WI) for graft. In PCL reconstructions, contrasting with ACL plasties,
optimal evaluation of the ligament graft [1, 5], ideally an magnetic susceptibility artifacts may truly hinder the evalua-
oblique sagittal plane following the course of the ligament tion of the graft because of a more proximal location of the

Fig. 6 Optimal tunnel

positioning. a–b Femoral tunnel
placement in a single bundle
technique: a In the sagittal plane
the opening (in blue) should be
located in the anterior half of the
insertion site of the native PCL
and (b) in the coronal plane, at 1
o’clock or 11 o’clock in the right
(as shown) and left knee,
respectively, 8–10 mm from the
articular margin. c–d Femoral
tunnel in double bundle
reconstructions. c In the sagittal
plane, the articular openings
should be located with one in the
anterior third of the native PCL
insertion site and the other in the
middle to distal third and (d) in
the coronal plane at 1 o’clock and
3 o’clock (right knee, as shown)
and at 11 o’clock and 9 o’clock
(left knee). e–f The tibial fixation
site (orange circles) in both
techniques (inlay and transtibial)
should be located (e) on the
sagittal plane, in the middle of the
posterior half of the retrospinal
surface, 8–15 mm distal to the
articular surface, and (f) on the
axial plane immediately medial to
the articular midline
Skeletal Radiol (2014) 43:1659–1668 1663

Fig. 7 Examples of incorrect tunnel positioning. a–b Excessively proxi- vertical course, associated with a diminished capability to resist posterior
mal position of the tibial tunnel in a patient with instability. a Sagittal tibial translation. c Sagittal PDI shows the femoral tunnel opening in an
MDCT image shows high articular opening of the tibial tunnel excessively posterior and high position (arrowhead) outside the optimal
(arrowhead) in the central region of the retrospinal line. Note the optimal position (blue rectangle) and exceeding the desired height
position (orange circle). b Sagittal PD MRI shows a PCL graft with a very

tibial fixation, especially in the tibial inlay technique [1, 2]. produce fewer artifacts, which tend to diminish over time [1,
Nonetheless, an acceptable evaluation of the intraarticular 12].
course of the graft is usually possible in isolated PCL recon- MDCT offers a more precise vision of the bony tunnels [5,
structions [1, 2, 12], but not in combined multiple ligament 7, 8] and serves to evaluate the status of the fixation material.
reconstructions. In general, gradient echo sequences are dis- A certain degree of assessment of soft tissue structures is
couraged, and the use of fat saturation (FS) sequences will be sometimes possible, and signs of instability may be appreci-
limited by the number of artifacts, which depends on the type ated, suggesting disruption or laxity of the plasty. CT scans are
and quantity of fixation material [1]. Resorbable materials usually requested in patients with a known failed PCL

Fig. 8 MRI of normal

postsurgical appearance of the
donor sites. a–b Donor site of a
BTB patellar tendon graft. a Axial
FS PDI shows a central defect and
slight thickening and increased
signal intensity in the patellar
tendon, a normal finding in the
early postoperative period. b
Axial T1WI demonstrates a bone
defect in the inferior pole of the
patella. c–d Donor site of a
hamstring graft. c Axial FS PD
1 month after surgery shows small
fluid laminar collections around
the course of the gracilis and
semitendinous tendons. The
tendon remnants are markedly
thin and show attenuated signal
intensity (arrows). d Follow-up
8 months after surgery
demonstrates resolution of the
soft tissue findings in the medial
region and restoration of the
normal thickness and signal in the
donor tendons (arrowheads)
1664 Skeletal Radiol (2014) 43:1659–1668

Fig. 9 Chronic disruption of the graft. a Sagittal PD FS MRI and b notch and double femoral tunnel (thick arrow). Note slight bone spurring
coronal T2WI FS. No graft is identified in the intercondylar region, with in the anterior tunnel opening (arrow). d MDCT 3D VR shows tibial
fluid occupying the theoretical course of the graft. As an indirect sign of tunnel opening (arrowhead). The articular opening of an ACL ligament
disruption, there is posterior displacement of the tibia (arrow in a). c reconstruction may be appreciated anteriorly (asterisk)
MDCT 3D VR for new ligament plasty planning shows the intercondylar

reconstruction who are to undergo a new ligament reconstruc- remodeling and resynovialization process called
tion and to determine the tunnel position, the condition of the “ligamentization,” transforming into a tissue similar to the
articular openings of the tunnels in search of stenosis and bone native PCL [1, 2, 4, 10]. During this phase, high T2WI signal
spurs, the tunnel inner contour and width, and the state of the intensity may appear that should not be mistaken for a tear or
surrounding bone so as to decide whether the existing tunnels impingement. The signal intensity should always be lower
are viable for the new reconstruction. In this setting, 3D than fluid signal [1], and fiber continuity must be observed.
volume-rendered reconstructions are helpful to surgeons since At 1–2 years after surgery, the appearance of the graft should
they clearly depict the position and shape of the articular be similar to the native PCL, hypointense on all sequences
tunnel openings and the intercondylar notch (see Fig. 9c–d). [1, 2, 4, 10] (Fig. 4).
The following information should be included in the post- Hamstring tendon grafts present a notable difference com-
operative imaging report: the employed surgical technique pared to BTB grafts due to their internal configuration with
and the type of fixation material, the status of the ligament
graft, and the morphology and position of the tunnels. Defor-
mity of the articular tunnel openings and abnormalities in the
bone surrounding the tunnel courses need to be described.
Preservation of the femorotibial alignment on sagittal images
should be assessed for signs of instability. Posterior translation
of the tibia with respect to the femur, the imaging equivalent to
the posterior drawer test, is an indirect sign of graft insuffi-
ciency [1, 7, 10]. Evidently, signs of complications, both
intraarticular or at the donor sites, need to be signaled. Any
fixation material displacement or rupture should be noted.

Normal postsurgical findings

Ligament graft

The MRI appearance of the PCL plasty varies significantly

depending on the type of graft, fixation technique and time
elapsed since the surgery [1, 10].
The MR signal intensity changes with the age of the graft,
i.e., the time elapsed since the surgery [1, 5, 10]. In the first 3–
4 months, the graft is avascular and will show hypointensity Fig. 10 Sagittal PD MRI in a patient with graft laxity shows buckling of
on all sequences, similar to the donor tendon [1]. At 4– the PCL graft and posterior displacement of the tibia (arrow), indicating
8 months after the surgery, the tendinous graft undergoes a instability
Skeletal Radiol (2014) 43:1659–1668 1665

Fig. 11 PCL graft impingement

in a patient with flexion-extension
limitation. a Sagittal and b axial
PD FS MRI shows thickening and
increased signal intensity of the
intraarticular course of the graft
(arrows)

several bundles: longitudinal linear images of intermediate or Tunnels

high signal intensity may be observed between the bundles,
representing a normal finding that would be clearly abnormal There are few publications on tunnel positioning in PCL
in a BTB graft, formed by a single bundle (Fig. 5) [1, 2, 4]. reconstructions [1, 2, 8]. Mariani et al. [8] published a method
These laminar collections are usually reabsorbed during the for evaluation with MRI and Gancel et al. [7] with CT, both
first or second year after surgery [1]. for reconstructions with a single femoral tunnel. Unifying
Arthrofibrosis is a very frequent finding in PCL reconstruc- both authors’ criteria and according to other publications in
tions, much more than in ACL plasties, owing mainly to the literature [2, 3, 5, 6, 11], the optimal location of the tunnels
movement restriction in the immediate postoperative period. may be simplified as follows (Fig. 6). The location of the
It is hypothesized that it may actually contribute to stabiliza- articular opening of the femoral tunnel depends on the number
tion of the knee, and therefore a certain degree of of bundles. In the single bundle technique, the opening will be
arthrofibrosis may be considered a normal finding, consider- located in the anterior half of the insertion site of the native
ing it does not limit the range of motion [1, 2, 13]. PCL (near the femoral insertion of the native AL bundle), at 1

Fig. 12 Arthrofibrosis. a Sagittal

PD MRI in a patient with a
flexion-extension limitation
following BTB grafting and
diffuse anterior arthrofibrosis.
Note the spiculated ill-defined
mass with low signal intensity in
Hoffa’s pad (thick arrow). b
Sagittal PD FS and c axial PD FS
in a patient with focal
arthrofibrosis. A hypointense
nodule surrounding the
intercondylar course of the PCL
graft may be identified (arrows).
d Arthroscopic image of the
“cyclops” lesion (asterisk)
1666 Skeletal Radiol (2014) 43:1659–1668

Fig. 13 Ganglion cyst formation

and widening of the tibial tunnel
in hamstring tendon grafts. a
Oblique sagittal T2WI shows a
fluid collection in the tibial tunnel
consistent with a ganglion cyst
(arrowhead) and mild widening
of the tunnel. d Sagittal MDCT
shows widening of the tibial
tunnel and focal irregularity of its
cortical lining (arrow)

o’clock or 11 o’clock in the right and left knee, respectively, edema may be seen around the tunnels and in the fixation sites
and 8–10 mm from the articular margin [2, 5–7]. In double on MRI [1]. A slight radiolucency around the tunnels may be
femoral bundle reconstructions, the articular opening sites appreciated on MDCT before fixation material incorporation,
should be located with one in the anterior third of the native and with time sclerosis of the tunnel margins may occur [6].
PCL insertion site and the other in the middle to distal third, at
1 o’clock and 3 o’clock (right knee) and at 11 o’clock and 9 Normal postsurgical appearance of the donor sites (Fig. 8)
o’clock (left knee) [5–11]. The tibial opening in both the inlay
and transtibial techniques should be located in the middle of
the posterior half of the retrospinal surface, immediately me- In the BTB technique, a central defect of about 5 mm in the
dial to the articular midline, 8–15 mm distal to the articular patellar tendon and small bone defects in the inferior pole of
surface. A small variability in tunnel positioning is allowed, the patella and tibial tuberosity will be appreciated. Initially,
and it is not clear what degree of precision is required to avoid the patellar tendon will appear thickened and with increased
complications [2, 3, 7, 8]. It is considered that a tunnel is signal intensity on T1- and T2WI. In the first 2 years following
abnormally placed when 75 % or more of the articular opening surgery, this defect will be occupied by a tissue indistinguish-
lies outside the anatomic insertion site [5]. able by MRI from the native tendon, showing hypointense
The most frequent mistakes in tunnel positioning (Fig. 7) signal intensity on all sequences.
are an excessively high and posterior situation of the femoral At the donor site of hamstring grafts, it is usual to see small
tunnel or an excessively proximal position of the tibial tunnel, laminar fluid collections following the course of the grafted
determining a vertically oriented graft with limited compe- tendons during the 1st months after surgery. In the following
tence to resist posterior tibial translation [5]. 6–12 months, signs of tendinous regeneration will be progres-
In the early postoperative period and up to 12 months sively appreciated, and after the 1st year, it is difficult to detect
following surgery, a variable degree of persistent bone marrow the postsurgical changes, except at the tibial insertion of the

Fig. 14 Complications with the

fixation material. a Axial PD MRI
shows an extruded interference
screw (arrow) protruding on the
soft tissues of the anteromedial
region of the knee. b Axial CT
image shows a superficially
placed Richards staple (arrow),
protruding on the soft tissues
adjacent to the extraarticular
opening of the tibial tunnel
(asterisk)
Skeletal Radiol (2014) 43:1659–1668 1667

grafted tendons (the distal 1–2 cm), which do not recover. long term may derive from a graft tear. Erroneous location of
There is generally no significant atrophy of the corresponding the tunnels or the killer turn (see Fig. 2) in the transtibial
muscles [1]. technique may cause a forced position of the ligament graft,
causing friction with the bony structures, which will eventu-
ally cause fraying, fibrosis, tears in the graft bundles and
subsequent complete disruption [1]. On MRI, thickening and
Complications high signal intensity on T1- and T2WI may be noticed in the
intraarticular course of the graft, which will not diminish but
Complications of the ligament graft will persist or worsen over time [1, 10]. This finding should
not be confused with the normal hyperintensity observed
According to the clinical symptoms, different complications during the remodeling phase, which should resolve. Another
may be distinguished: sign of impingement is buckling of the graft at the articular
opening of the tunnels [1].
1. An unstable knee indicates graft failure due to disruption Significant arthrofibrosis may cause pain and flexion-
or laxity. extension limitation of the knee and requires arthroscopic
2. Limitation of flexion-extension of the knee may be sec- resection [1, 10]. There are two types of arthrofibrosis
ondary to graft impingement, arthrofibrosis or intraarticular (Fig. 12), focal and diffuse [1]. Focal arthrofibrosis is also
loose bodies [1, 12]. known as a “cyclops lesion” because of its arthroscopic ap-
3. Persistent knee pain may be due to multiple causes. pearance and consists of a nodule of fibrous tissue typically
located around the PCL graft or in Hoffa’s fat pad [1, 2]. Due
Disruption of the PCL graft (Fig. 9) can occur at any to its fibrous nature, it appears hypointense on all sequences,
moment following reconstruction, but the graft is most vul- although the T2WI signal intensity is variable [1, 2, 10]. The
nerable during ligamentization [1, 10]. Rupture of the graft diffuse form generally presents as a spiculated, ill-defined
may be caused by a new traumatic mechanism or by chronic mass of low signal intensity [1].
impingement. Absence of visualization of the graft and pres- Ganglion cyst formation (Fig. 13a) is associated with wid-
ence of a full-thickness defect of fluid signal intensity are the ening of the tunnels, but there is controversy as to its relation
most specific signs of graft disruption [1, 2, 10]. Posterior with graft failure [1, 10]. It is more common with hamstring
displacement of the tibia may be present as an indirect sign of tendon grafts and allografts [1, 5]. Ganglion cysts are formed
disruption [1, 7, 10]. in the interior of the tibial tunnel and as they grow may
Laxity or stretching of the PCL graft (Fig. 10), more protrude into the joint or into the soft tissues adjacent to the
likely with hamstring grafts, should be considered if extraarticular opening of the tunnel [1]. They may be asymp-
there is knee instability with integrity of the graft fibers tomatic or cause pain, flexion-extension limitation or a palpa-
on MRI. Bowing or buckling of the plasty may be ble mass [1]. On MDCT these lesions appear as a fluid density
observed. In the majority of cases, surgical intervention mass or as widening of the tunnels with wall remodeling and
is required to recover stability, by means of either graft loss of definition of the cortical borders. On MRI, a lobulated
tightening or new ligament reconstruction [1]. cystic structure can be observed [1].
Graft impingement (Fig. 11) is a noteworthy complication, Widening of the tunnels (Fig. 13b) may be caused by
since it presents with a flexion-extension limitation, but in the incomplete incorporation of the graft in the tunnel or by the

Fig. 15 Complications at the donor site of a patellar tendon BTB graft. a increased signal intensity in the proximal region of the patellar tendon
Sagittal PD MRI shows altered signal intensity and mild thickening of the indicating tendinopathy. c Sagittal MDCT image shows heterotopic ossi-
patellar tendon, suggesting tendinopathy, and avulsion of a small bone fied foci in the patellar tendon (arrowhead)
fragment from the proximal insertion (arrow). b Marked thickening and
1668 Skeletal Radiol (2014) 43:1659–1668

effect of a ganglion cyst, although in the majority the cause Signs of graft failure must be identified along with the factors
remains unknown [10]. Widening is considered significant if that may contribute to it, as well as other potential complica-
there is an increase of 50 % or more in the area of the tunnel tions. Further studies are required to establish specific criteria
[5]. Movement of the graft inside the tunnel may occur, for tunnel positioning in PCL reconstructions.
termed the “windshield wiper effect” [10], but it does not
usually have relevant consequences.
Fixation material may shift or rupture (Fig. 14) [6]. If
Conflict of interest The authors declare that they have no conflict of
fixation material protrudes into the periarticular soft tissues, interest.
it may cause pain, inflammatory changes, development of
fluid collections, etc. In the case of resorbable material, reac-
tive synovitis in the 1st months following surgery is common.
Bone resorption leading to the appearance of cysts may also References
occur during incorporation.
1. Sanders TG. MR imaging of postoperative ligaments of the knee.
Complications at the donor sites Semin Musculoskelet Radiol. 2002;6(1):19–33.
2. Sherman PM, Sanders TG, Morrison WB, Schweitzer ME, Leis HT,
Complications at the donor sites are more frequent in the BTB Nusser CA. MR imaging of the posterior cruciate ligament graft:
technique (Fig. 15) [1, 10], presenting with pain in the anterior initial experience in 15 patients with clinical correlation. Radiology.
2001;221(1):191–8.
compartment of the knee and patellar tendon degeneration. 3. Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior
Thickening>10 mm or hyperintensity on MRI that persists cruciate ligament. Anatomy, biomechanics and outcomes. Am J
over time suggests patellar tendinopathy and should not be Sports Med. 2012;40(1):222–31.
mistaken with the normal findings of the early postoperative 4. Yoon YC, Chung HW, Ahn JH. MR imaging of stable posterior
cruciate ligament grafts in 21 arthroscopically proven cases. Korean
period [1, 10]. Residual patella baja, patellar tendon rupture J Radiol. 2007;8:403–9.
and patellar fracture are rare complications [1, 6, 10]. 5. Noyes FR, Barber-Westin SD. Posterior cruciate ligament
In the donor site of hamstring tendon grafts, there may be revision reconstruction, part 1: causes of surgical failure in
weakness or persistent pain. Rupture of the native tendons, 52 consecutive operations. Am J Sports Med. 2005;33(5):
646–54.
generally due to overharvesting, is exceptional [1, 14]. 6. Manaster BJ, Remley K, Newman AP, Mann FA. Knee
ligament reconstruction: plain film analysis. AJR. 1988;150:
Other complications 337–42.
7. Gancel E, Magnussen RA, Lustig S, Demey G, Neyret P, Servien E.
Tunnel position following posterior cruciate ligament reconstruction:
Unnoticed deficiency of other ligaments such as the ACL or an in vivo computed tomography analysis. Knee. 2011. doi: 10.1016/
posterolateral corner structures causes instability that could j.knee.2011.04.003 .
derive from the failure of the PCL reconstruction and progres- 8. Mariani PP, Adriani E, Belleli A, Maresca G. Magnetic resonance
sion of osteoarthritic changes [5]. Underlying varus imaging of tunnel placement in posterior cruciate ligament recon-
struction. Arthroscopy. 1999;15(7):733–40.
malalignment may also contribute to failure of the plasty [5]. 9. Otero F, Fernández Lopera JF. Reconstrucción interarticular
The presence of intraarticular loose bodies due to chondral simultánea: LCA doble haz más LCP doble haz. Descripción de
lesions or meniscal fragments may limit knee flexion- técnica quirúrgica. Rev Colomb de Ortop y Traumatología.
extension and produce blocking. Obviously, in PCL recon- 2007;21:257–65.
10. Cerezal Pesquera L, Acosta Batllé J, Canga Villegas A. Radiología
structions complications universal for any articular surgery esencial. Tomo 1. Madrid: Médica Panamericana. Radiología
may also occur [6]: reactive synovitis, septic arthritis, deep posquirúrgica del aparato locomotor; 2009. p. 927–928.
venous thrombosis, etc., which are not of particular interest in 11. Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision
this article. reconstruction, part 2: results of revision using a 2-strand quadriceps
tendon-patellar bone autograft. Am J Sports Med. 2005;33(5):
655–65.
12. Berquist TH. Imaging of orthopedic fixation devices & prosthesis.
Philadelphia: Lippincott, Williams & Wilkins. Chapter 6: The Knee.
Conclusions 2009. p. 278–291.
13. Buess E, Imhoff A, Hodler J. Knee evaluation in two systems
and magnetic resonance imaging after operative treatment of
It is important to acknowledge the different PCL reconstruc- posterior cruciate ligament injuries. Arch Ortop Trauma Surg.
tion techniques and their normal postsurgical appearance. 1996;115:307–12.