Planned Tunnel Convergence for Concomitant Posterior Cruciate Ligament Reconstruction and Meniscal Root Repair

Meniscal root injuries frequently occur in the setting of multiligamentous knee injuries. These present a complicating factor for planned tunnels and fixation owing to their proximity to the posterior cruciate ligament (PCL) tibial tunnel. Techniques typically aim to avoid tunnel convergence to reduce the risk of damage to grafts and/or fixation devices and decrease the risk of osteolysis or loss of fixation. We describe a method for planned tunnel convergence for PCL reconstruction and meniscal root repair. The PCL tibial tunnel is first drilled in the typical trajectory. An anterior cruciate ligament drill guide is then placed at the appropriate footprint for the medial or lateral meniscal root, with the starting point at the proximal tibia sharing the same external tibial tunnel aperture as the PCL. Sutures capturing the meniscal root and the PCL graft can then both be passed and exit distally via the same converging tunnel and can be fixed to the proximal tibia using standard techniques. The described technique can be used for either the medial or lateral meniscal root with concomitant PCL reconstruction in a safe and controlled method to reconstruct the native anatomy and avoid tunnel collision with inadvertent injury to grafts or fixation.