Purpose: The purpose of the study was to better define the tibial insertion of the posterior
cruciate ligament (PCL) and to identify landmarks that could be used to aid in placement
of independent tibial tunnels for a 2-bundle PCL reconstruction. Type of Study: Descriptive anatomic study. Methods: Ten knees from 8 cadavers were dissected and the PCL was identified. The ligament
was peeled away from its insertion and the sides of the insertion site were measured
and recorded. The 4 corners of the insertion site were identified and marked. Observations
were made of the morphology of the insertion site and the presence of any reproducible
anatomic landmarks. A note was made of landmarks that could be easily identified on
all of the specimens by direct vision and by palpation with a probe. Results: The ligament consisted of 2 regions, 1 anterolateral, and 1 posteromedial, with a
gradual change in the laxity of the ligament as the knee was passed through flexion
and extension. The insertion site was situated in a depression between the plateaus
of the tibia and extended below the articular surface. The average length ± standard
deviation of the 4 sides was 128 ± 21.2 mm (medial side), 107 ± 26.5 mm (superior
side), 160 ± 30.0 mm (lateral side), and 169 ± 34.5 mm (inferior side). The shape
and sides of the insertion site were visually similar among the 10 specimens. The
superolateral and superomedial corners were both represented by depressions and a
reproducible ridge represented the inferior border. These structures could be visualized
as well as palpated on all specimens. Conclusions: Based on the findings of this study, we describe the anatomic characteristics of
the tibial footprint of the PCL. Anatomic reference points that represent the corners
of the tibial insertion of the PCL were identified by direct vision or palpation consistently
on all specimens included in the study. These reference points could potentially aid
in the placement of an anterolateral and posteromedial tibial tunnel for a 2 tibial
tunnel PCL reconstruction. Clinical Relevance: Reproducible anatomic reference points exist at the tibial insertion of the PCL that
can be identified by direct vision and palpation. These reference points may potentially
aid in the placement of separate tibial tunnels for a 2-bundle PCL reconstruction.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term follow-up of the untreated isolated posterior cruciate ligament-deficient knee.Am J Sports Med. 1996; 24: 306-310
- Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure.J Bone Joint Surg Am. 1983; 65: 310-322
- Nonoperatively treated isolated posterior cruciate ligament injuries.Am J Sports Med. 1993; 21: 132-136
- Posterior cruciate ligament tibial inlay reconstruction.Arthroscopy. 1995; 11: 69-76
- Double tunnel technique for reconstruction of the posterior cruciate ligament.Oper Tech Sports Med. 1999; 7: 110-117
- PCL 2002.Arthroscopy. 2002; 18 (Nov-Dec): 40-52
- Posterior cruciate ligament reconstruction using autogenous central quadriceps tendon.Oper Tech Sports Med. 1999; 7: 281-288
- Posterior cruciate ligament tibial inlay technique—Principles and procedure.Oper Tech Sports Med. 1999; 7: 127-133
- The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis.Clin Orthop. 1975; 106: 216-231
- Anatomy of the posterior cruciate ligament. A review.Am J Sports Med. 1989; 17: 24-29
- Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction.Am J Sports Med. 2000; 28: 144-151
- Loading of the two bundles of the posterior cruciate ligament.J Biomech. 1996; 29: 873-879
- Isolated posterior cruciate ligament reconstruction. Long-term results.Am J Sports Med. 1993; 21: 490-496
- Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study.Am J Sports Med. 1998; 26: 395-401
- The effect of knee flexion angle and application of an anterior tibial load at the time of graft fixation on the biomechanics of a posterior cruciate ligament-reconstructed knee.Am J Sports Med. 2000; 28: 460-465
- PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts.J Bone Joint Surg Br. 1998; 80: 173-179
- Posterior cruciate ligament femoral insertion site characteristics. Importance for reconstructive procedures.Am J Sports Med. 2002; 30: 643-651
- Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction.Arthroscopy. 1994; 10: 546-549
Article info
Identification
Copyright
© 2005 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
