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

Lee, Yong Seuk; Jong, Ho; Ahn, Jin Hwan; Ha, Jeong Ku; Kim, Jin Goo

doi:10.1016/j.arthro.2010.06.024

Cited by 27 publications

(42 citation statements)

References 15 publications

(19 reference statements)

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“…9 Alguns estudos sobre o LCP não descreveram separadamente a localização das bandas AL e PM. 10,12,16 Verificamos que o centro de inserção da banda PM esteve sempre medial e distal ao centro de inserção da banda AL. Nas radiografias em AP, a distância média entre os centros das inserç ões das bandas AL e PM até a borda medial da tíbia foi de 40,68 ± 4,10 mm e de 38,74 ± 4,40 mm, respectivamente.…”

Section: Resultsunclassified

Estudo radiográfico da inserção tibial do ligamento cruzado posterior

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Esquerdo

Almagro

et al. 2015

Revista Brasileira de Ortopedia

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r e v b r a s o r t o p . 2 0 1 5;5 0(3):342-347 w w w . r b o . o r g . b r Artigo Original Estudo radiográfico da inserção tibial do ligamento cruzado posterior ଝ informações sobre o artigo Histórico do artigo: Recebido em 5 de fevereiro de 2014 Aceito em 11 de junho de 2014 On-line em 16 de setembro de 2014 Palavras-chave: Tíbia Ligamento cruzado posterior/radiografia Cadáver r e s u m o Objetivo: Estabelecer as distâncias radiográficas dos centros das inserç ões tibiais do ligamento cruzado posterior (LCP) até as corticais medial e lateral da tíbia, nas radiografias em anteroposterior, e desses centros até o ponto mais proximal da faceta do LCP, nas radiografias em perfil, para que possam orientar a criação de túneis anatômicos na reconstrução do LCP e para análise pós-operatória do posicionamento dos túneis. Desenho: Estudo laboratorial controlado. Métodos: Vinte joelhos de cadáveres foram avaliados. As inserç ões tibiais das bandas do LCP foram identificadas e demarcadas com marcadores metálicos e os joelhos foram radiografados. Nas radiografias determinamos a localização do centro de inserção das bandas relativa à medida mediolateral da tíbia e as distâncias do ponto mais proximal da faceta do LCP até o centro de inserção das bandas. Todas as medidas foram calculadas com o software ImageJ.Resultados: Nas radiografias em anteroposterior a distância média entre o centro da inserção da banda anterolateral (AL) até a borda medial da tíbia foi de 40,68 ± 4,10 mm; a distância entre o centro de inserção da banda posteromedial (PM) até a borda medial da tíbia foi, em média, de 38,74 ± 4,40 mm. Nas radiografias em perfil as distâncias médias entre o ponto mais proximal da faceta do LCP e os centros de inserção das bandas AL e PM foram de 5,49 ± 1,29 mm e 10,53 ± 2,17 mm, respectivamente.Conclusões: Foi possível estabelecer um padrão radiográfico das inserç ões tibiais das bandas do LCP que pode ser útil para o controle intraoperatório da localização dos túneis e para análise pós-operatória da posição dos túneis.

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Section: Resultsunclassified

Estudo radiográfico da inserção tibial do ligamento cruzado posterior

Gali

Esquerdo

Almagro

et al. 2015

Revista Brasileira de Ortopedia

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“… 9 Some studies on the PCL have not described the locations of the AL and PM bands separately. 10 , 12 , 16 …”

Section: Discussionmentioning

confidence: 99%

Radiographic study on the tibial insertion of the posterior cruciate ligament

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Esquerdo

Almagro

et al. 2015

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo establish the radiographic distances from posterior cruciate ligament (PCL) tibial insertions centers to the lateral and medial tibial cortex in the anteroposterior view, and from these centers to the PCL facet most proximal point on the lateral view, in order to guide anatomical tunnels drilling in PCL reconstruction and for tunnel positioning postoperative analysis.Study designControlled laboratory study.MethodsTwenty cadaver knees were evaluated. The PCL's bundles tibial insertions were identified and marked out using metal tags, and the knees were radiographed. On these radiographs, the bundles insertion sites center location relative to the tibial mediolateral measure, and the distances from the most proximal PCL facet point to the bundle's insertion were determined. All measures were calculated using the ImageJ software.ResultsOn the anteroposterior radiographs, the mean distance from the anterolateral (AL) bundle insertion center to the medial tibial edge was 40.68 ± 4.10 mm; the mean distance from the posteromedial (PM) bundle insertion center to the medial tibial edge was 38.74 ± 4.40 mm. On the lateral radiographs, the mean distances from the PCL facet most proximal point to AL and PM bundles insertion centers were 5.49 ± 1.29 mm and 10.53 ± 2.17 mm respectively.ConclusionsIt was possible to establish a radiographic pattern for PCL tibial bundles insertions, which may be useful for intraoperative tunnels locations control and for postoperative tunnels positions analysis.

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“…The tibial guide tip (Acufex, Smith&Nephew, Andover, MA, USA) was placed about 1 cm below the articular surface and just lateral to the midline on the PCL fossa 2,15. The tibial guide pin was passed through the starting point of the tibial tunnel at 2 cm posterolateral from the anterior tibial tuberosity and about 4 cm below the joint line.…”

Section: Methodsmentioning

confidence: 99%

Femoral Graft-Tunnel Angles in Posterior Cruciate Ligament Reconstruction: Analysis with 3-Dimensional Models and Cadaveric Experiments

et al. 2013

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PurposeThe purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft.Materials and MethodsTwelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0°, 45°, 90°, and 120°). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees.ResultsBetween 45° and 120° of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p<0.001). In cadaveric experiments using pressure-sensitive film, the maximum contact pressure for the modified inside-out and outside-in technique was significantly lower than that for the conventional inside-out technique (p=0.024 and p=0.017).ConclusionThe conventional inside-out technique results in a significantly lesser GTA and higher stress at the intra-articular aperture of the femoral tunnel than the outside-in technique. However, the results for the modified inside-out technique are similar to those for the outside-in technique.

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

Cited by 27 publications

References 15 publications

Estudo radiográfico da inserção tibial do ligamento cruzado posterior

Estudo radiográfico da inserção tibial do ligamento cruzado posterior

Radiographic study on the tibial insertion of the posterior cruciate ligament

Femoral Graft-Tunnel Angles in Posterior Cruciate Ligament Reconstruction: Analysis with 3-Dimensional Models and Cadaveric Experiments

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