MRI analysis of tibial PCL attachment in a large population of adult patients: reference data for anatomic PCL reconstruction

Teng, Yuanjun; Guo, Laiwei; Meng, Wei; Xu, Tianen; Zhao, Lianggong; Jiang, Jin; Sheng, Xiaoyun; Xu, Li; Zhang, Bo; Ding, Ning; Xia, Yayi

doi:10.1186/s12891-016-1232-3

Cited by 9 publications

(9 citation statements)

References 37 publications

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“…determined no advantages of double-bundle over single-bundle PCL reconstruction, with respect to clinical outcomes or posterior knee stability [ 10 ]. Furthermore, single-bundle PCL reconstruction techniques have focused more on arthroscopic and radiographic reference points instead of the historical non-anatomic “isometric’’ reconstruction, with initial occurring joint over-constraint and progressive joint laxity described as complications [ 2 , 3 , 8 , 10 , 18 , 20 , 25 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Successful reconstruction of the posterior cruciate ligament: assessment of posterior cruciate ligament footprints using an objective coordinate system

et al. 2020

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Introduction Anatomic cruciate ligament reconstruction is known to be correlated with better clinical results. The aim of the study was to provide a simple method to enable anatomic results in the setting of PCL reconstruction. We, therefore, assessed the tibial and femoral insertion site of the posterior cruciate ligament (PCL) by the use of an objective coordinate system in an anatomical study. We also sought to show reproducibility of these measurements using intra- and inter-observer coefficients. Materials and methods We studied 64 knees, previously preserved according to Thiel’s technique. After proper preparation of the articular surfaces of both the tibiae and femora, photographs were taken according to a standardized protocol. PCL footprints were measured by the use of a coordinate system twice by two examiners. We evaluated these measurements by use of the Cohen’s kappa inter- and intra-observer coefficient for two observers. Results Tibial and femoral measurements of PCL footprints were generated with highly comparable inter- ( k = 0.970) and intra-observer ( k = 0.992) coefficients and may, therefore, be considered as highly reproducible. Conclusion Our findings confirmed the reproducibility of defining PCL footprints using a coordinate system and may contribute to planning intraoperative graft-placement to ensure optimal conditions in the upcoming techniques for PCL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Successful reconstruction of the posterior cruciate ligament: assessment of posterior cruciate ligament footprints using an objective coordinate system

et al. 2020

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“…The PCL tibial attachment was regarded as the tibial tunnel exit point, and cylinders with a radius of 5 mm were built to simulate the tibial tunnels. The position of the cylinder was slightly adjusted on the 3D knee model to ensure that it was accurately showing the exit was at the tibial PCL attachment point (Figure 1C), which referred to the MRI measurement data obtained from a previous study of the tibial PCL attachment point 27 …”

Section: Methodsmentioning

confidence: 99%

“…The position of the cylinder was slightly adjusted on the 3D knee model to ensure that it was accurately showing the exit was at the tibial PCL attachment point (Figure 1C), which referred to the MRI measurement data obtained from a previous study of the tibial PCL attachment point. 27 The Method to Simulate Different Tibial Tunnel Approaches When locating the entrance of the tibial tunnel, a right triangle was formed on the proximal tibial cross section as described by a study by Noyes et al, 28 in which the anteromedial tibial cortex has an oblique or triangular shape, whereas the anterolateral tibial cortex is almost perpendicular to the posterior margin of the tibia (Figure 2A). The midpoint of the tibial crest was located on the cross section, then the midpoint and the anterior 1/3 point of the parts of the anteromedial and anterolateral tibia cortex that overlapped with the triangle were located respectively (Figure 2B).…”

Section: Simulation Of Transtibial Posterior Cruciate Ligament Recons...mentioning

confidence: 99%

“…With respect to sex, there was no significant difference in the mean value of the PSA, but there were significant differences in the TTH and TTD between male and female (Table 1). With respect to age, the included patients were divided into a young group (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), a middle-aged group (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) and an elderly group (46-60) (Table 2). The outcome parameters showed that the mean value of PSA of T4 in the middle-age group was significantly lower than that in the young (P = 0.026), Both the TTH and TTD (T4 and T5) of the middle-age and the elderly groups were significantly higher than that of the young group (P < 0.05).…”

Section: Subgroup Analysis In Terms Of Sex Age and Heightmentioning

confidence: 99%

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The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

Teng

Jia

et al. 2022

Orthopaedic Surgery

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Objective To determine the permissive safe angle (PSA) of the tibial tunnel in transtibial posterior cruciate ligament (PCL) reconstruction based on a three‐dimensional (3D) simulation study. Methods This was a computer simulation study of transtibial PCL reconstruction using 3D knee models. CT images of 90 normal knee joints from 2017 to 2020 were collected in this study, and 3D knee models were established based on CT data. The tunnel approaches were subdivided into the anterior 1/3 of the anteromedial tibia (T1), middle 1/2 of the anteromedial tibia (T2), the tibial crest (T3), anterior 1/3 of the anterolateral tibia (T4), middle 1/2 of the anterolateral tibia (T5). Five tibial tunnels (T1–T5) were simulated on the 3D knee models. The PSAs, in different tibial tunnel approaches were measured, and subgroup analyses of sex, age and height were also carried out. Results The mean PSAs of the tibial tunnels with 5 different approaches (T1–T5) were 58.49° ± 6.82°, 61.14° ± 6.69°, 56.12° ± 7.53°, 52.01° ± 8.89° and 49.90° ± 10.53°, respectively. The differences of the mean PSAs between the anteromedial and anterolateral approaches were significant (P < 0.05). However, there was no significant difference of the mean PSA value between the two anteromedial tibial tunnel approaches (T1–T2) (P > 0.05), as well as between the two anterolateral tibial tunnel approaches (T4–T5). The patient's anthropomorphic characteristics of sex, age, and height were not associated with the PSAs. Conclusions The PSA varied with the anteromedial, tibial crest and anterolateral approaches for transtibial PCL reconstruction, and surgeons should limit the PCL drill guide by referring to the specific PSA for different surgical approaches.

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“…Posterior cruciate ligament (PCL) injury is a common type of acute knee injuries, accounting for 1% to over 40% [1][2][3][4]. This injury is an important cause of knee joint kinematic diseases such as joint hyperextension and joint instability, which is mainly caused by sporting activities (38.8%) and tra c accidents (35%) [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Time-Zero Biomechanical Study of the Effective Length of the Graft in Posterior Cruciate Ligament Reconstruction

Teng

Liu

et al. 2021

Preprint

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Background The effect of effective length on the biomechanical properties of the graft is regarded as an essential variable influencing the posterior cruciate ligament reconstruction. However, the effect has not been fully studied. The purpose was to compare the effects of different effective graft lengths (35 mm, 55 mm, 65 mm) on the time-zero biomechanical properties of the graft in posterior cruciate ligament (PCL) reconstruction.Methods Bovine digital flexor tendons and porcine tibias were used to establish in-vitro PCL reconstruction models. Tensile strength testing was performed at 3 different effective lengths of the graft: short (35 mm, n = 10, group 1), medium (55 mm, n = 10, group 2), and long (65 mm, n = 10, group 3). A computer software (Trapezium X; Shimadzu) was used to record the load-elongation curve, ultimate load (N), the elongation of the graft during the test (mm), tensile stiffness (N/mm), and energy absorption (J). The failure pattern was evaluated by visual observation.Results All the samples failed because the grafts slipped out from the bones, except two grafts ruptured in group 1. The tensile stiffness and ultimate load in group 1 were significantly higher than those in group 2 and group 3 (tensile stiffness, 50.49 ± 11.43 N/mm in group 1 vs 31.20 ± 10.44 N/mm in group 2[P < 0.001] and 19.18 ± 6.18 N/mm in group 3 [P < 0.001]; ultimate load, 452.40 ± 54.52 N in group 1 vs 338.50 ± 26.79 N in group 2 [P < 0.001]and 268.70 ± 28.30 N in group 3 [P < 0.001]). There were significant differences between group 1 and group 3 in energy absorption(9.61 ± 3.25 J vs 5.22 ± 2.43 J, P = 0.002). At 50 N and 100 N of applied load, no statistically significant differences were detected on the elongation of the grafts (P > 0.05). The elongation of the short grafts under 150 N and 200 N of applied load was significantly less than that of the long grafts (150 N, 1.77 ± 0.83 mm in group 1 vs 4.14 ± 1.75 mm in group 3, P = 0.047; 200 N, 2.62 ± 1.10 mm in group 1 vs 7.06 ± 3.20 mm in group 3, P = 0.006).Conclusions This study demonstrated the time-zero biomechanical properties of the graft with short effective length were superior to those of the graft with medium and long effective lengths in PCL reconstruction.

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MRI analysis of tibial PCL attachment in a large population of adult patients: reference data for anatomic PCL reconstruction

Cited by 9 publications

References 37 publications

Successful reconstruction of the posterior cruciate ligament: assessment of posterior cruciate ligament footprints using an objective coordinate system

Successful reconstruction of the posterior cruciate ligament: assessment of posterior cruciate ligament footprints using an objective coordinate system

The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

A Time-Zero Biomechanical Study of the Effective Length of the Graft in Posterior Cruciate Ligament Reconstruction

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