Anatomic Characteristics and Radiographic References of the Anterolateral and Posteromedial Bundles of the Posterior Cruciate Ligament

Abstract

Accurate definition of the insertion sites of the PCL is essential for anatomic double-bundle reconstruction. The results of our study may be used as a reference for intraoperative and postoperative assessments of correct femoral and tibial tunnel placements.

The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

“…For the femoral tunnel the corresponding values were 42.21 ± 8.34 % of the total intercondylar depth [27], 13.21 ± 4.88 % of the total intercondylar height [27] and 56±6°for the angle segment α [20].…”

“…After surgery axial high-resolution CT scans with frontal, sagittal and volume rendered 3D reconstructions according to a standardised knee protocol were obtained on the second postoperative day. The determination of anatomic intra-articular tibial and femoral tunnel apertures was derived from previous investigations on a radiographic and arthroscopic reference system of the native PCL insertion areas [11,14,20,27]. According to recommendations in the literature [25], the replication of the posteromedial bundle was avoided when creating the femoral graft tunnel.…”

“…According to recommendations in the literature [25], the replication of the posteromedial bundle was avoided when creating the femoral graft tunnel. The threshold value for desired tunnel position representing an anatomic replication of the anterolateral bundle of the PCL was defined as the mean position±standard deviation (SD) [27]: for the tibial tunnel this was 50.93±5.59 % of the total mediolateral diameter of the tibial plateau [27], 8.27±2.34 mm inferior to the connecting line between the medial and the lateral tibial plateau on frontal images [27], 8±1 mm inferior to the anteroposterior tangent of the tibial plateau on lateral images [20] and exactly at the level of the previous physeal line [4].…”

“…From the biomechanical point of view, anatomic replication of the native PCL footprint has been advocated [22,27]. Therefore, several authors have studied the anatomy of the PCL insertion areas [2,13,30] and provided radiographic data to correlate these anatomic findings to intra-and postoperative skeletal radiography and computed tomography (CT) scans [11,14,20,26,27].…”

“…Therefore, several authors have studied the anatomy of the PCL insertion areas [2,13,30] and provided radiographic data to correlate these anatomic findings to intra-and postoperative skeletal radiography and computed tomography (CT) scans [11,14,20,26,27]. Standardised measurement grid systems and thresholds for the aspired tibial and femoral tunnel positions have been established [7,11,14,20,27].…”