Purpose
To compare the outside-in transtibial lateral and medial approaches for posterior
cruciate ligament (PCL) reconstruction regarding the guidewires and popliteal artery
integrity.
Methods
Twenty-two human cadaveric knees were used. A PCL tibial aimer was arthroscopically
placed within the PCL footprint through the anteromedial portal for the medial approach
and through the anterolateral portal for the lateral approach. For the medial approach,
the drill guide was introduced through the anteromedial tibial cortex and the guidewire
was advanced with the reamer beyond the posterior tibial cortex. For the lateral approach,
the drill guide was introduced through the anterolateral tibial cortex and the guidewire
was advanced with the reamer beyond the posterior tibial cortex. After this, the knee
was dissected. The depth distance (DD) was defined as the distance between the popliteal
artery and the tibial posterior cortex projected at the tibial level at which the
guidewire intersected or passed by the artery. The guidewire travel distance was calculated
as the distance the guidewire had to advance beyond the tibial cortex to intersect
the popliteal artery or pass by it.
Results
With the medial approach, the popliteal artery was intersected in all knees with a
mean DD of 12.20 mm and a mean guidewire travel distance of 15.90 mm. With the lateral
approach, the popliteal artery was not intersected in any knee; its mean medial distance
from the artery was 4.8 mm at a DD of 10.05 mm. There was a significant difference
in the popliteal artery intersection incidence and DD between both groups (P < .0001 and P = .0003, respectively).
Conclusions
The transtibial lateral approach for PCL reconstruction was a safer method than the
medial approach regarding popliteal artery injury by a guidewire.
Clinical Relevance
This study presents a slight modification of the most frequently used PCL reconstruction
technique, intending to minimize guidewire injury to the popliteal artery.
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Article info
Publication history
Accepted:
July 2,
2014
Received:
March 10,
2014
Footnotes
This study was performed at the Smith & Nephew laboratory in Andover, Massachusetts. The authors received no funding.
The authors report the following potential conflict of interest or source of funding: C.E.d.S.F., L.J.B.A., F.N.R., A.C.M., M.d.A.e.S.M., R.K., and R.J.A. receive support from Pró-Cirurgia Especializada (PCE). Support for travel was paid by PCE for them to act as faculty in an arthroscopic knee training course. They are consultants for PCE in Brazil.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
