Tibial Insertion of the Posterior Cruciate Ligament: A Sagittal Plane Analysis Using Gross, Histologic, and Radiographic Methods

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

“…4 Several studies have examined the anatomy of the PCL insertion. 4,[11][12][13] Girgis et al 14 reported that it was 2 to 3 mm distal to the articular plane, and Takahashi et al 13 reported that the anterolateral bundle insertion was located virtually on the articular plane (close to 0 mm) and the posteromedial bundle insertion was located a mean of 4.6 mm distal to the articular plane. Moorman et al 4 reported that the more posterior fibers, which insert up to 20 mm down the posterior cortex of the tibia, posterior and inferior to the posterior intercondylar fossa, are 0.5 mm thick.…”

“…4,14 Anatomically, this insertion is distinct from the vertical cortex of the tibia and can serve as a consistent radiographic landmark for pin placement in PCL reconstruction. 4 We found that the PCL insertion was in the posterior 48% of the area of the PCL fovea, to the posterior cortex, consistent with Moorman et al 4 (posterior half of posterior intercondylar fossa).…”

“…By use of sagittal CT of the posterior intercondylar fossa at 1-mm slices, the ratio of the sagittal insertional length of the PCL to the total length of the entire posterior intercondylar fossa was calculated (Fig 3). 4 The distance of the sagittal PCL insertion was measured from the anteriorly positioned screw to the posteriorly positioned screw that was inserted at the corner of the PCL insertion.…”

“…[1][2][3] Less attention has been paid to the placement of the tibial tunnel during posterior cruciate ligament (PCL) reconstruction than to the femoral tunnel. 4 Furthermore, for the tibial tunnel in the PCL, the focus has been to prevent the killerturn effect and neurovascular injury. [5][6][7][8] The posterior aspect of the proximal tibia has a unique 3-dimensional anatomy compared with the mid or distal tibia, because multiple structures change abruptly, including the tibial plateau, posterior intercondylar fossa, and posterior cortex.…”

“…The PCL inserts to the sloping central depression between the medial and lateral portions of the tibial plateau, and this insertion is distinct from the vertical cortex of the tibia (Fig 1A and 1B). 4 For transtibial PCL reconstruction, plain radiographs or C-arm images are frequently used during the creation of the tibial tunnel. On the lateral plain ra-diograph, the images of the medial and lateral tibial condyles overlap.…”