Posterior Cruciate Ligament Tibial Insertion Anatomy and Implications for Tibial Tunnel Placement

2011 ◽  
Vol 27 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Yong Seuk Lee ◽  
Ho Jong Ra ◽  
Jin Hwan Ahn ◽  
Jeong Ku Ha ◽  
Jin Goo Kim
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Placement ◽  
Tibial Insertion

scholarly journals Revision of Failed-Posterior Cruciate Ligament (PCL) Reconstruction Due To Tibial Tunnel Misplacement: A Case Report

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0047
Author(s):  
Andri Lubis ◽  
Mohamad Walid Kuncoro
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Rare Condition ◽  
Anatomical Site ◽  
Pcl Reconstruction ◽  
Tunnel Placement ◽  
Posterior Aspect ◽  
Additional Tool ◽  
Portal Technique

Objectives: Posterior cruciate ligament (PCL) reconstruction failure is a rare condition found. The failure caused by some factors, including improper graft tunnel placement. The proper tibial tunnel placement in PCL reconstruction is still controversial. To have an anatomical tunnel is essential to decrease the risk of failure. The use of PCL jig only to guide the direction of the tibial tunnel may not always give good results. Case presentation: We report a case of a 29-year-old male with a total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with a transseptal portal technique to ensure the tibial tunnel is placed inappropriate position. Result: The cause of failure was associated with the miss position of the tibial tunnel. The tibial tunnel performed in previous surgery was too anterior than the anatomical footprint. This condition might be caused by a surgical technique that depending only on PCL jig to guide the tibial tunnel direction and location. We performed a transseptal portal technique to get better visualization on the posterior aspect of the knee to achieve the proper direction of the tibial tunnel. Conclusion: The use of PCL jig as the only tool for guiding tibial tunneling should be avoided. An additional tool such as a transseptal portal is required to ensure the proper anatomical tibial tunnel to achieve good PCL graft placement.

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

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098515
Author(s):  
Kyoung Ho Yoon ◽  
Jung-Suk Kim ◽  
Jae-Young Park ◽  
Soo Yeon Park ◽  
Raymond Yeak Dieu Kiat ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Resonance Imaging ◽  
Pcl Reconstruction ◽  
Tunnel Placement ◽  
Group A

Background: There is currently no consensus on the optimal placement of the tibial tunnel for remnant-preserving posterior cruciate ligament (PCL) reconstruction. Purpose/Hypothesis: The purpose of this study was to compare the clinical and radiologic outcomes of remnant-preserving PCL reconstruction using anatomic versus low tibial tunnels. We hypothesized that the outcomes of low tibial tunnel placement would be superior to those of anatomic tibial tunnel placement at the 2-year follow-up after remnant-preserving PCL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the data for patients who underwent remnant-preserving PCL reconstruction between March 2011 and January 2018 with a minimum follow-up of 2 years (N = 63). On the basis of the tibial tunnel position on postoperative computed tomography, the patients were divided into those with anatomic placement (group A; n = 31) and those with low tunnel placement (group L; n = 32). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity level), range of motion, complications, and stability test outcomes at follow-up were compared between the 2 groups. Graft signal on 1-year follow-up magnetic resonance imaging scans was compared between 22 patients in group A and 17 patients in group L. Results: There were no significant differences between groups regarding clinical scores or incidence of complications, no between-group differences in posterior drawer test results, and no side-to-side difference on Telos stress radiographs (5.2 ± 2.9 mm in group A vs 5.1 ± 2.8 mm in group L; P = .900). Postoperative 1-year follow-up magnetic resonance imaging scans showed excellent graft healing in both groups, with no significant difference between them. Conclusion: The clinical and radiologic outcomes and complication rate were comparable between anatomic tunnel placement and low tibial tunnel placement at 2-year follow-up after remnant-preserving PCL reconstruction. The findings of this study suggest that both tibial tunnel positions are clinically feasible for remnant-preserving PCL reconstruction.

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