Editorial Commentary: Stump Sparing or Footprint Exposing? Management of the Tibial Remnant During Posterior Cruciate Ligament Reconstruction

Jarvis, D. Landry; Waterman, Brian R.

doi:10.1016/j.arthro.2019.05.035

Cited by 3 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,7 The distinct attachment sites of the 2 PCL bundles not only are suggestive of their synergistic and co-dominant role in knee biomechanics but also offer a technical advantage for safe tunnel placement when double-bundle reconstruction is attempted. The study by Forsythe et al 5 adds to the series of recent work that has attempted to recognize important aspects in PCL reconstruction, such as the position of the femoral tunnel, 8 the importance of fixation, 9 the timing from injury to reconstruction, 10 the graft bending angle, [11][12][13] the role of the tibial slope, 14 the role of remnant tissue, 15,16 and the optimization of grafts. 17,18 The number of published articles about PCL injury showed an exponential increase in the past decade, reaching 76.9 and 82.9 articles published per year in the PubMed and Scopus databases, respectively (Fig 1).…”

Section: See Related Article On Page 2875mentioning

confidence: 99%

Editorial Commentary: The Posterior Cruciate Ligament Posteromedial Bundle Is Small but Vital to Posterior Cruciate Ligament Biomechanics: Don’t Ignore the Underdog

Paschos¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Posterior cruciate ligament (PCL) reconstruction leads to outcomes less favorable than those of anterior cruciate ligament reconstruction. In recent years, we have seen a surge of publications regarding PCL anatomy, isometry, and reconstruction techniques. PCL reconstruction has been revolutionized with lessons learned from analysis of PCL behavior, such as the distinct role of the posteromedial bundle (PMB) in the biomechanics of the knee at different flexion angles, as well as its co-dominant role with its counterpart, the anterolateral bundle. With the knee in extension, the PMB serves to restrict posterior translation, whereas in knee flexion, the PMB restricts internal rotation. It is rather too early to know whether the biomechanical advantage of double-bundle reconstruction will result in better clinical outcomes in the long term; however, the increased interest and the refinement of both single-and double-bundle reconstruction techniques will certainly advance our knowledge, ultimately translating into better patient outcomes.

show abstract

Section: See Related Article On Page 2875mentioning

confidence: 99%

Editorial Commentary: The Posterior Cruciate Ligament Posteromedial Bundle Is Small but Vital to Posterior Cruciate Ligament Biomechanics: Don’t Ignore the Underdog

Paschos¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown that preserving the PCL stump and posterior septum during PCLR is essential for graft survival because these structures are rich in mechanoreceptors and blood vessels [ 14 – 16 ]. Konrads et al followed up 21 patients with intraoperative preservation of the posterior septum from 6 to 12 months, all patients had no joint effusion, and the mean difference in tibial posterior displacement on stress radiographs was 4.1 mm on the healthy and affected side [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

Niu,

Chen,

Jin

et al. 2024

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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.

show abstract

“…For example, the PCL remnant is helpful for revascularization of grafts, thereby promoting graft healing. 10 The mechanoreceptors in remnant fibers also preserve proprioception. 5,14,15 Moreover, several authors have demonstrated that the PCL remnant works like a soft tissue cushion to prevent the “killer-turn” effect at the tunnel orifice.…”

mentioning

confidence: 99%

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

Yoon

Kim

Park

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

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.

show abstract

Editorial Commentary: Stump Sparing or Footprint Exposing? Management of the Tibial Remnant During Posterior Cruciate Ligament Reconstruction

Cited by 3 publications

References 20 publications

Editorial Commentary: The Posterior Cruciate Ligament Posteromedial Bundle Is Small but Vital to Posterior Cruciate Ligament Biomechanics: Don’t Ignore the Underdog

Editorial Commentary: The Posterior Cruciate Ligament Posteromedial Bundle Is Small but Vital to Posterior Cruciate Ligament Biomechanics: Don’t Ignore the Underdog

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

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

Contact Info

Product

Resources

About