Comparable Clinical and Radiologic Outcomes Between an Anatomic Tunnel and a Low Tibial Tunnel in Remnant-Preserving Posterior Cruciate Ligament Reconstruction

Yoon, Kyoung Ho; Kim, Jung-Suk; Park, Jae Young; Park, Soo Yeon; Kiat, Raymond Yeak Dieu; Kim, Sang-Gyun

doi:10.1177/2325967120985153

Cited by 4 publications

(18 citation statements)

References 33 publications

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“…With the development of arthroscopic techniques, PCL reconstruction is becoming a common treatment strategy for PCL injuries. Precise anatomical positioning of the graft tunnel is essential for obtaining good PCL reconstruction outcomes 21 . However, at present, the positioning of the bone tunnel for PCL reconstruction, under arthroscopic surgery, mainly depends on direct vision and intraoperative imaging positioning during surgery.…”

Section: Discussionmentioning

confidence: 99%

Application of CT‐MRI Fusion‐Based Three‐Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament

Feng

Wang

Jin

et al. 2022

Orthopaedic Surgery

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Objective During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient‐specific anatomical data, we established a three‐dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction. Methods This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three‐dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t‐tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant. Results All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1‐LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1‐LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne‐glass drop‐off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment‐related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm2, respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm2, respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas. Conclusion In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Application of CT‐MRI Fusion‐Based Three‐Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament

Feng

Wang

Jin

et al. 2022

Orthopaedic Surgery

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“…These results were consistent with those in two recent studies, who reported the postoperative outcomes of the distal tibial tunnel in PCL reconstruction. 20,41 Lin et al 20 included 15 patients who underwent PCL reconstruction using distal tibial tunnel. They found that a distal tunnel significantly reduced the killer turn, but the clinical outcome was similar with that of anatomic tibial tunnel within a mean follow-up of 35.4 months.…”

Section: Discussionmentioning

confidence: 99%

“…They found that a distal tunnel significantly reduced the killer turn, but the clinical outcome was similar with that of anatomic tibial tunnel within a mean follow-up of 35.4 months. Yoon et al 41 retrospectively reviewed the clinical and radiologic outcomes of patients undergoing PCL reconstruction with anatomic and low tibial tunnels. The findings showed similar clinical and radiologic outcomes between anatomic and distal tibial tunnel at 2-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of proximal, distal, and anatomic tibial tunnel for transtibial posterior cruciate ligament reconstruction

Teng

Jia

Lü

et al. 2022

Proc Inst Mech Eng H

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No consensus has been reached on the optimal position of PCL tibial tunnel. The purpose of this study was to compare the biomechanical properties of proximal, distal and anatomic tibial tunnel in transtibial posterior cruciate ligament reconstruction. An in-vitro model of transtibial posterior cruciate ligament reconstruction was simulated using porcine tibias and bovine extensor tendons. Two models of biomechanical testing, load-to-failure loading, and cyclic loading, were performed in this study. The load-to-failure loading found that distal tibial tunnel resulted in greater ultimate load and yield load than the anatomic and proximal tunnel group ( p < 0.05), whereas there were no significant differences in mean tensile stiffness among three groups ( p > 0.05). The cyclic loading found no differences in the graft displacement at 250, 500, and 1000 cycles among three groups ( p > 0.05). It was found that distal tibial tunnel showed superior ultimate load and yield load in load-to-failure loading testing compared with proximal and anatomic tibial tunnels, whereas no significant difference was found in terms of the mean displacement of the survived grafts in cyclic loading testing among three groups.

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“… 6 However, efforts have kept been made to preserve the remnant during PCL reconstruction with the expectation of better surgical results. 7 , 8 , 9 , 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation

Zhao

2021

Arthroscopy Techniques

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Remnant always exists following injuries of the posterior cruciate ligament (PCL). To improve the clinical outcomes of PCL reconstruction, preservation of the remnant has long been a consideration. However, how to make the remnant-preservation technique simple and more effective is of concern. We describe a single-bundle anatomical PCL reconstruction technique with remnant preservation in which the posteromedial and posterolateral portals are used, the graft is placed at the lateral side of the remnant, and pulleys are used to facilitate graft passage at the 2 killer turns of the grafting routes. We consider introduction of this technique will provide reasonable choices in PCL reconstruction.

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Comparable Clinical and Radiologic Outcomes Between an Anatomic Tunnel and a Low Tibial Tunnel in Remnant-Preserving Posterior Cruciate Ligament Reconstruction

Cited by 4 publications

References 33 publications

Application of CT‐MRI Fusion‐Based Three‐Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament

Application of CT‐MRI Fusion‐Based Three‐Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament

Biomechanical comparison of proximal, distal, and anatomic tibial tunnel for transtibial posterior cruciate ligament reconstruction

Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation

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