Tibial Insertions of the Posterior Cruciate Ligament: Topographic Anatomy and Morphometric Study

Abstract

Objective To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. Material and methods The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles’ tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles’ insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. Results In 54.2% of the knees the insertion’ shape was concave; in most pieces (41.6%) the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm 2 ; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm 2 and it was 41.54 ± 9.75 mm 2 for the posteromedial bundle. Conclusions The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.