Purpose
The purposes of this study were (1) to predict the tibial insertion of the posterior
cruciate ligament (PCL) and posterior cortex that aligned with the tibial tunnel (PCTT)
by use of 2-dimensional plain radiographs by evaluating the relation between plain
radiograph and computed tomography (CT) images and (2) to determine the safe angle
of the tibial guide for preventing breakage of the posterior cortex.
Methods
In 10 fresh cadaveric tibias, the soft tissues were dissected and the tibial footprint
of the PCL was identified. The insertion of the PCL, the longest distance from the
PCTT to the posterior cortex that aligned with the tibial plateau (PCTP), and the
possible maximum angle of the tibial guide to the most posteriorly positioned cortical
line were measured from simple anteroposterior (AP) and lateral radiographs, as well
as CT.
Results
The mean tibial insertion of the PCL from the joint line was located between 5.9 ±
1.1 and 17.4 ± 2.4 mm on the simple AP radiographs and between 2.2 ± 1.2 and 12.3
± 1.5 mm on the simple lateral radiographs (P = .005). The PCL insertion was from the posterior 48% of the area of the posterior
intercondylar fossa to the posterior cortex. The longest distance from the PCTT to
the PCTP was 10.8 ± 2.2 mm. The maximum angle of the tibial guide to the PCTT possible
on CT and the PCTP on lateral radiographs was 52° ± 5° and 62° ± 4.5°, respectively
(P = .005).
Conclusions
The mean tibial insertion of the PCL from the joint line was located higher on the
lateral radiographs than on the AP radiographs, and the PCL insertion was in the posterior
48% of the area of the PCL fovea to the posterior cortex. The maximum possible angle
of the tibial guide to the PCTT based on CT was 52°. Therefore the angle of the tibial
guide pin must be limited for tibial footprint reconstruction to prevent posterior
wall breakage.
Clinical Relevance
Increasing the tibial guide angle may have some advantages, but there is a limit because
of posterior wall breakage.
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
Forsythe B, Kopf S, Wong AK, et al. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418-1426.
Kopf S, Martin DE, Tashman S, Fu FH. Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92:871-881.
van Eck CF, Lesniak BP, Schreiber VM, Fu FH. Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258-268.
- Tibial insertion of the posterior cruciate ligament: A sagittal plane analysis using gross, histologic, and radiographic methods.Arthroscopy. 2008; 24: 269-275
- Transtibial double bundle posterior cruciate ligament reconstruction using TransFix tibial fixation.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 973-977
- Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal.Arthroscopy. 2003; 19: 101-107
- Posterior cruciate ligament tibial inlay reconstruction.Arthroscopy. 1995; 11: 69-76
- Arthroscopic posterior cruciate ligament tibial inlay reconstruction.Arthroscopy. 2004; 20: 149-154
- Anterior cruciate ligament graft positioning, tensioning and twisting.Knee Surg Sports Traumatol Arthrosc. 1998; 6: S2-S12
- Magnetic resonance arthrographic findings of presumed stage-2 adhesive capsulitis: Focus on combined rotator cuff pathology.Orthopedics. 2009; 32: 22
- The attachments of the fiber bundles of the posterior cruciate ligament: An anatomic study.Arthroscopy. 2007; 23: 284-290
- Morphology of the tibial insertion of the posterior cruciate ligament.J Bone Joint Surg Am. 2009; 91: 859-866
- Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 1055-1059
- The cruciate ligaments of the knee joint.Clin Orthop Relat Res. 1975; : 216-231
- An anatomical and biomechanical comparison of anteromedial and anterolateral approaches for tibial tunnel of posterior cruciate ligament reconstruction: Evaluation of the widening effect of the anterolateral approach.Am J Sports Med. 2009; 37: 1777-1783
Article info
Publication history
Published online: October 18, 2010
Accepted:
June 23,
2010
Received:
November 10,
2009
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
