Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position

Alentorn-Geli, Eduard; Stuart, Joseph J.; Choi, J. H. James; Toth, Alison P.; Moorman, Claude T.; Taylor, Dean C.

doi:10.1007/s00167-015-3958-0

Cited by 13 publications

(23 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recurrent posterior relaxation is one of the most common complications after PCL reconstruction 10 . Previous studies have revealed that the sharp graft angulation between the graft and the tibial plateau caused a high compressive force to the graft in transtibial PCL reconstruction, which was named as killer turn 4,11,12,35,36 . Several studies have found that the killer turn can be reduced by increasing the angle of the tibial tunnel relative to the tibial plateau 12,15 .…”

Section: Discussionmentioning

confidence: 99%

The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

Teng

Jia

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective To determine the permissive safe angle (PSA) of the tibial tunnel in transtibial posterior cruciate ligament (PCL) reconstruction based on a three‐dimensional (3D) simulation study. Methods This was a computer simulation study of transtibial PCL reconstruction using 3D knee models. CT images of 90 normal knee joints from 2017 to 2020 were collected in this study, and 3D knee models were established based on CT data. The tunnel approaches were subdivided into the anterior 1/3 of the anteromedial tibia (T1), middle 1/2 of the anteromedial tibia (T2), the tibial crest (T3), anterior 1/3 of the anterolateral tibia (T4), middle 1/2 of the anterolateral tibia (T5). Five tibial tunnels (T1–T5) were simulated on the 3D knee models. The PSAs, in different tibial tunnel approaches were measured, and subgroup analyses of sex, age and height were also carried out. Results The mean PSAs of the tibial tunnels with 5 different approaches (T1–T5) were 58.49° ± 6.82°, 61.14° ± 6.69°, 56.12° ± 7.53°, 52.01° ± 8.89° and 49.90° ± 10.53°, respectively. The differences of the mean PSAs between the anteromedial and anterolateral approaches were significant (P < 0.05). However, there was no significant difference of the mean PSA value between the two anteromedial tibial tunnel approaches (T1–T2) (P > 0.05), as well as between the two anterolateral tibial tunnel approaches (T4–T5). The patient's anthropomorphic characteristics of sex, age, and height were not associated with the PSAs. Conclusions The PSA varied with the anteromedial, tibial crest and anterolateral approaches for transtibial PCL reconstruction, and surgeons should limit the PCL drill guide by referring to the specific PSA for different surgical approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

Teng

Jia

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…The insertion of the PCL on the posterior tibial upslope can be clearly visualized surgically at the time of reconstruction by having the appropriate amount of soft tissue and PCL remnant debridement. Various techniques such as the utilization of a 70° arthroscope, posterolateral portal approach, a midline trans-patellar tendon approach, or a posterior trans-septal portal approach technique have been shown from previous studies to have a better visualization of the retained PCL remnant [5], [6], [10], [14], [15], [16]. However, there are potential surgery associated morbidities related to additional portals techniques as well as the implementation of variable angle arthroscopic techniques.…”

Section: Discussionmentioning

confidence: 99%

“…These were related to several factors, including intercondylar notch mechanical blockage, inexperienced surgeon, and degenerative joint disease cases. The failure of triangulation of the arthroscope and the instrument has been acknowledged by many arthroscopic surgeons to be the cause of unsuccessful arthroscopic procedures in certain areas of the posterior compartment [5], [6], [10], [14], [15], [16]. The previous study stated that PCL reconstruction with PCL remnant preservation gave good healing capacity and possible proprioception [10], [8].…”

Section: Discussionmentioning

confidence: 99%

“…Surgeon can use only anterior portal, anterior and trans-septal portal, and anterior and anterolateral portal in PCL reconstruction procedure. However, there are no consensuses about the best and the most recommended technique in PCL reconstruction has been reached [1], [2], [3], [4], [5], [6], [7]. PCL injury usually preserves both femoral and tibial insertion at PCL and meniscofemoral ligament [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

Рhatomy¹,

Saspraditya²,

Setyawan³

2020

Open Access Maced J Med Sci

View full text Add to dashboard Cite

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

show abstract

“…In addition, there are often various medical procedures carried out in the area near to the nerve trunk, which may cause iatrogenic damage to the nerve or its final branches (12)(13)(14)(15). Therefore, it is of anatomical and clinical importance to know the variability of the final division of the common fibular nerve (FDCFN).…”

Section: Introductionmentioning

confidence: 99%

Topography of the common fibular nerve terminal division in human foetuses

2022

View full text Add to dashboard Cite

Background:The progress of pediatric surgery and increasingly better diagnosis of fetal defects require detailed knowledge of human developmental anatomy. Precise knowledge of the anatomy of innervation of the lower extremities corresponds to this subject and is not only cognitive but also clinically important. The end of the common fibular nerve is superficially located in the area exposed to frequent injuries as well as in the area subject to possible surgical repair procedures. Materials and methods:The analysis was carried out on 200 human foetuses aged from the 113 th day to 222 nd day of foetal life. The study material is a part of local fetal collection. The study incorporated the following methods: anthropological, preparational and image acquisition which was acquired with the use of high-resolution digital camera. Statistical analysis was carried out with the use of STATISTICA package. Results:Based on the research results the new typology of the examined nerve was determined. The head of the fibula was the criterion: (i) high divisionabove the head of the fibula (1%); (ii) intermediate divisionat the height of the head of the fibula (34%); (iii) low divisionbelow the head of the fibula (65%). The mathematical analysis did not reveal statistically significant bilateral and gender differences. Moreover the additional branch was observed in 30% of fetuses, regardless of age class. This branch occurred in 50% of cases in both sides of the fetus. This nerve was defined as the accessory fibular nerve (nervus fibularis/peroneus accessorius). Conclusions:The created unique typology of the terminal division of common fibular nerve is an important supplement to the anatomical knowledge and at the same time, due to the peripheral and superficial location of the described structures, it has a relatively high clinical significance.

show abstract

Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position

Cited by 13 publications

References 16 publications

The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

The Permissive Safe Angle of the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Three‐Dimensional Simulation Study

Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

Topography of the common fibular nerve terminal division in human foetuses

Contact Info

Product

Resources

About