Radiographic Landmarks for Tunnel Positioning in Posterior Cruciate Ligament Reconstructions

Abstract

This study established a set of clinically relevant radiographic guidelines for anatomic reconstruction of the PCL. The parameters set forth in this study can be used in both the intraoperative and postoperative settings for both single- and double-bundle PCL reconstructions.

Radiographic Identification of Arthroscopically Relevant Proximal Femoral Structures

“…First, our specimen sample was relatively small but no smaller than in other radiographic studies with similar methodologies. 12,17,18,23 Additionally, our measurements were quantitative and were applied to hips of variable sizes. In an attempt to address this discrepancy and to increase clinical relevance, both quantitative and qualitative descriptions of all landmarks were provided.…”

The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

“…Prior research focused either on biomechanical laboratory testing or on functional outcome. Even though these reports specified tunnel positions to be anatomic, their intra-articular accurate aperture is rarely demonstrated despite the availability of radiomorphometric data that Medians with ranges and frequencies correlate anatomy and postoperative imaging [14,20,26,27]. A controlled laboratory study by Markolf et al [25] revealed that normal PCL force profiles for most modes of loading are produced with an anterolateral femoral tunnel, whereas a posteromedial and central tunnel position yielded significant increases in graft forces.…”

“…This might be one reason for similar group results without statistically significant differences. Nevertheless, tunnels were accepted to be anatomic if they matched the defined radiographic recommendations in the literature [14,20,26,27]. The important role of the replication of anatomic footprints has been elucidated [5,25,28,31,32], but the clinical effect remains unclear.…”

“…After surgery axial high-resolution CT scans with frontal, sagittal and volume rendered 3D reconstructions according to a standardised knee protocol were obtained on the second postoperative day. The determination of anatomic intra-articular tibial and femoral tunnel apertures was derived from previous investigations on a radiographic and arthroscopic reference system of the native PCL insertion areas [11,14,20,27]. According to recommendations in the literature [25], the replication of the posteromedial bundle was avoided when creating the femoral graft tunnel.…”

“…Therefore, several authors have studied the anatomy of the PCL insertion areas [2,13,30] and provided radiographic data to correlate these anatomic findings to intra-and postoperative skeletal radiography and computed tomography (CT) scans [11,14,20,26,27]. Standardised measurement grid systems and thresholds for the aspired tibial and femoral tunnel positions have been established [7,11,14,20,27].…”