Posterior cruciate ligament is twisted and flat structure: new prospective on anatomical morphology

Kato, Tomohiro; Śmigıelski, Robert; Ge, Yunshen; Zdanowicz, Urszula; Ciszek, Bogdan; Ochi, Mitsuo

doi:10.1007/s00167-017-4634-3

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…Similar to rectangular anterior cruciate ligament reconstruction, the use of a flat graft combined with a rectangular femoral tunnel mimics the native PCL insertion and biomechanics, facilitating graft twisting during knee flexion. 12 , 13 Moreover, a rectangular footprint on the femur created by a rasp or dilator covers the anatomic insertional area more efficiently than a conventional round footprint created by a reamer, 14 , 16 whereas on the tibial side, a round bone tunnel seems appropriate. Siebold et al.…”

Section: Discussionmentioning

confidence: 99%

“…8 Recent evidence has pointed out that the PCL at the midsubstance is flat, with a twisted ribbonlike appearance, without clearly separate bundles. 9 , 10 , 11 , 12 The femoral insertion of the PCL is flat and high in the notch. Moreover, at the level of the medial meniscus, the fiber layers of the PCL have an arc-like appearance and are attached to the tibial insertion site.…”

mentioning

confidence: 99%

“…These anatomic characteristics, in addition to the obliquely functional axis of the ribbon, produce a twisting effect during flexion and extension of the knee, acting as multiple bundles. 12 , 13 For these reasons, the use of round tunnels and tubular grafts as the optimum reconstruction technique has to be questioned. As previously reported for anterior cruciate ligament reconstruction, anatomically oriented rectangular bone tunnels may more closely replicate the anatomy and biomechanics of the native PCL, allowing a twisting effect of the graft during knee flexion.…”

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confidence: 99%

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Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts

Fink

Farinelli²,

Abermann³

et al. 2023

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts

Fink

Farinelli²,

Abermann³

et al. 2023

Arthroscopy Techniques

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“…The bene t of our technique under-the-ACL was the remnant tissues including the Humphrey and Wrisberg ligament keep intact because it could locate the tibial tunnel insertion from the lateral of PCL and get around the PCL remnant bers. Preservation of the remnant posterior cruciate ligament (PCL) could be considered to promote graft healing and support graft properties [10,11]. In addition, the PCL graft is healed together with the remnant PCL bers at the femoral and tibial attachment sites, and they form a broad cross-sectional area, similar to original double-bundle PCL [10,12].…”

Section: Discussionmentioning

confidence: 99%

The tibial tunnel location would be lateral easiler by placing the tunnel under-the-ACL During transtibial Posterior Cruciate Ligament Reconstruction with remnant preservation

Zhao-lan

Chao-xi

Wei-lin

et al. 2022

Preprint

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Background：An accurate method for precise tibial tunnel preparation and preserving remnant are believed as the key technologies of transtibial PCL reconstruction. However, there are technically difficult when creating an accurate tibial tunnel under good visualization without removing the remnant PCL fibers. We found tibial guide could through the path under-the-ACL(between the ACL and lateral femoral condyle) to posterolateral compartment at 45° Knee flexion and varus stress, while tibial guide tip can locate the insertion from the lateral of PCL and get around the PCL remnant and ACL fibers; placing tunnel inferolaterally and preserving remnant intactly will be easily at the same time . Purpose : (1) report a modified technique for tibial tunnel preparation to place the tunnel at inferolateral position easily without remnant’s block in PCL reconstruction with remnant preservation. (2) compare tibial tunnel placement of two guide path by in vivo 3-dimensional computed tomography（3D-CT）:the path under-the-ACL（the guide insertion we recommend）and the path over-the-ACL（the guide insertion we used to）. Methods： Tibial tunnel aperture location was analyzed by postoperative in vivo CT in 50 patients who underwent single-bundle remnant-preserving PCL reconstruction ,22 by over-the-ACL and 28 by under-the-ACL tibial guide insertion techniques by a retrospective study from 2016 to 2020 to our center. Tibial tunnel positions were measured in the medial to lateral and proximal to distal directions of the posterior proximal tibia. Stress radiography of pre- and post-operation were used to evaluate the knee stability. Results：All patients were follow-up above 24 months. In the medial to lateral direction, the center of tibial tunnel aperture was located more laterally in the under-the-ACL group of (0.51±0.01)% than over-the-ACL group of (0.46±0.04)%（P＜0.05）. The tibial tunnel position in the proximal to distal direction, determined by absolute value and relative percentage, were similar in the 2 groups. Two groups were significantly improved the posterior laxity control compared with preoperation by stress radiography at 24 months postoperatively, and posterior tibial translation (4.00±1.03)mm in A group compared with (5.43±1.09)mm in B group（P＜0.05）. Conclusions: Tibial tunnel apertures would be located more laterally after under-the-ACL tibial guide insertion than after over-the-ACL tibial guide insertion. There was, however, no significant difference between these techniques in distance from the joint line to the tibial tunnel aperture. Insertion under-the-ACL to the PCL stump may result in better placement of the PCL in Fanelli area.

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“…The length and cross-sectional area of the PCL are 32-38 mm and 31.2 mm [2,4,12]. The width of the PCL mid-substance is 13.3 ± 2 mm [13].…”

Section: Anatomymentioning

confidence: 98%

Single Versus Double-Bundle PCL Reconstruction: Scientific Rationale and Clinical Evidence

Tucker

Joyner

Endres

2018

Curr Rev Musculoskelet Med

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There is some recent evidence demonstrating biomechanical superiority of double-bundle versus single-bundle reconstruction; however, this is not definitive. Clinical superiority has not been clearly demonstrated as of yet. The primary question which served as the basis of this review remains unanswered. There is recent biomechanical data to suggest a potential benefit of double-bundle versus single-bundle reconstruction, but not all studies are in agreement. Furthermore, the possible biomechanical advantages have not yet been borne out in clinical studies. At this point, we cannot clearly recommend one technique versus another and the decision should be left to the treating surgeon.

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Posterior cruciate ligament is twisted and flat structure: new prospective on anatomical morphology

Cited by 17 publications

References 39 publications

Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts

Posterior Cruciate Ligament Reconstruction Using Flat Soft-Tissue Grafts

The tibial tunnel location would be lateral easiler by placing the tunnel under-the-ACL During transtibial Posterior Cruciate Ligament Reconstruction with remnant preservation

Single Versus Double-Bundle PCL Reconstruction: Scientific Rationale and Clinical Evidence

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