Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

Tibial Tunnel Aperture Location During Single-Bundle Posterior Cruciate Ligament Reconstruction: Comparison of Tibial Guide Positions

“…10 Despite the lack of statistical significance, the finding that insertion lateral to the PCL stump resulted in a tibial aperture location 2.3 mm closer to the articular surface or 2.3 mm higher in the proximal to distal direction than insertion medial to the PCL stump may be caused by the ability of the PCL remnant to constrain the distal extent of the guide tip in the former group, in which the PCL tibial stump center was targeted in the proximal to distal direction. Previous studies 15,16,21 have not included detailed descriptions of the methods used to insert tibial drill guides in patients undergoing transtibial PCL reconstruction. Rather, only the course of tibial guide insertiondstarting from the anteromedial portal, through the intercondylar notch, and advancing to the PCL tibial attachmentdhas been described.…”

“…[15][16][17] A recent study regarding the isometry of 2 different paths for PCL reconstruction suggested 2 tibial tunnel guide insertion methods: (1) medial to the PCL stump, in which the tibial tunnel guide is inserted between the PCL remnant and the medial femoral condyle, allowing the tibial guide to pass under the PCL and (2) lateral to the PCL stump, in which the guide is inserted between the PCL and the ACL, allowing the tibial guide to pass over the PCL. 18 To our knowledge, no in vivo 3-dimensional computed tomography (3D-CT) studies have compared these 2 methods of tibial tunnel guide insertion during single-bundle PCL reconstructions.…”

Arthroscopic Transtibial Posterior Cruciate Ligament Reconstruction with Preservation of Posterior Cruciate Ligament Fibers

“…with the same surgical technique for PCL reconstruction via the posterior transseptal portal. 1 This method allows a greater working range with an improved exposure of the PCL tibial attachment site, which lies 10 mm below the articular surface. 2 Furthermore, it decreases the risk of injuring any posterior neurovascular structures and allows the surgeon to properly position the transtibial tunnel with minimal damage to the retained distal tibial stump of the PCL (Figure 1).…”

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

“…4 Furthermore, for the tibial tunnel in the PCL, the focus has been to prevent the killerturn effect and neurovascular injury. [5][6][7][8] The posterior aspect of the proximal tibia has a unique 3-dimensional anatomy compared with the mid or distal tibia, because multiple structures change abruptly, including the tibial plateau, posterior intercondylar fossa, and posterior cortex. The PCL inserts to the sloping central depression between the medial and lateral portions of the tibial plateau, and this insertion is distinct from the vertical cortex of the tibia (Fig 1A and 1B).…”