A modified anatomical posterior cruciate ligament reconstruction technique using the posterior septum and posterior capsule as landmarks to position the low tibial tunnel.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968565 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2474 (Electronic) Linking ISSN: 14712474 NLM ISO Abbreviation: BMC Musculoskelet Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-

Posterior Cruciate Ligament Reconstruction* ; Posterior Cruciate Ligament*/diagnostic imaging ; Posterior Cruciate Ligament*/surgery; Humans ; Tibia/diagnostic imaging ; Tibia/surgery ; Knee Joint/diagnostic imaging ; Knee Joint/surgery ; Lower Extremity/surgery ; Cadaver ; Femur/surgery

Background: Lowering the exit position of the tibial tunnel can improve the clinical efficacy of posterior cruciate ligament (PCL) reconstruction, however, there is no unified positioning standard. This study aimed to use novel soft tissue landmarks to create a low tunnel.
Methods: A total of 14 human cadaveric knees and 12 patients with PCL injury were included in this study. Firstly, we observed the anatomical position between the PCL, posterior septum, and other tissue, and evaluated the relationship between the center of the low tibial tunnel (SP tunnel) and posterior septum and distal reflection of posterior capsule, and using computed tomography (CT) to evaluate distance between the center of the SP tunnel with bony landmarks. Then, evaluated the blood vessels content in the posterior septum with HE staining. Finally, observed the posterior septum and distal reflection of the posterior capsule under arthroscopy to explore the clinical feasibility of creating a low tibial tunnel, and assessed the risk of surgery by using ultrasound to detect the distance between the popliteal artery and the posterior edge of tibial plateau bone cortex.
Results: In all 14 cadaveric specimens, the PCL tibial insertions were located completely within the posterior medial compartment of the knee. The distance between the center of the SP tunnel and the the articular surface of tibial plateau was 9.4 ± 0.4 mm. All SP tunnels retained an intact posterior wall, which was 1.6 ± 0.3 mm from the distal reflection of the posterior capsule. The distances between the center of the SP tunnel and the the articular surface of tibial plateau, the champagne glass drop-off were 9.2 ± 0.4 mm (ICC: 0.932, 95%CI 0.806-0.978) and 1.5 ± 0.2 mm (ICC:0.925, 95%CI 0.788-0.975) in CT image. Compared with the posterior capsule, the posterior septum contained more vascular structures. Last, all 12 patients successfully established low tibial tunnels under arthroscopy, and the distance between the posterior edge of tibial plateau bone cortex and the popliteal artery was 7.8 ± 0.3, 9.4 ± 0.4 and 7.4 ± 0.3 mm at 30°, 60° and 90° flexion angels after filling with water and supporting with shaver in posterior-medial compartment of knee joint.
Conclusions: A modified low tibial tunnel could be established in the PCL anatomical footprint by using the posterior septum and posterior capsule as landmarks.
(© 2024. The Author(s).)

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2022LCTD-B25 "14th Five-Year" clinical medicine Innovation Research Team Support program of Hebei Medical University; project name: Biological and kinematic study on accurate location of tibial soft reference in posterior cruciate ligament reconstruction Science and Technology Department of Hebei Province assisted Xinjiang science and technology plan project; No. 82172460 National Natural Science Foundation of China

Keywords: Anatomy; Posterior capsule; Posterior cruciate ligament; Posterior septum; Tibial tunnel

Date Created: 20240118 Date Completed: 20240122 Latest Revision: 20240122

20240122

PMC10795373

10.1186/s12891-024-07176-9

38238705