What Is the Maximum Tibial Tunnel Angle for Transtibial PCL Reconstruction? A Comparison Based on Virtual Radiographs, CT Images, and 3D Knee Models

Teng, Yuanjun; Da, Lijun; Jia, Gengxin; Hu, Jie; Liu, Zhongcheng; Zhang, Shifeng; Han, Hua; Xia, Yayi

doi:10.1097/corr.0000000000002111

Cited by 10 publications

(30 citation statements)

References 35 publications

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“…With respect to sex, there was no significant difference in the mean value of the PSA, but there were significant differences in the TTH and TTD between male and female (Table 1). With respect to age, the included patients were divided into a young group (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), a middle-aged group (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) and an elderly group (46-60) (Table 2). The outcome parameters showed that the mean value of PSA of T4 in the middle-age group was significantly lower than that in the young (P = 0.026), Both the TTH and TTD (T4 and T5) of the middle-age and the elderly groups were significantly higher than that of the young group (P < 0.05).…”

Section: Subgroup Analysis In Terms Of Sex Age and Heightmentioning

confidence: 99%

“…The 3D knee model simulation is a novel method which could provide an in-vitro virtual technique to simulate the tibial tunnel. 25 Previous studies have reported, the 3D knee model could be used in precise quantitative analysis and has excellent measurement accuracy and reliability. 26 Based on the 3D knee model, the tibial tunnel could be monitored in real time, and the PSAs in different tibial tunnel approaches could be accurately measured and analyzed in 3D space.…”

Section: Introductionmentioning

confidence: 99%

“…The 3D knee model simulation is a novel method which could provide an in‐vitro virtual technique to simulate the tibial tunnel 25 . Previous studies have reported, the 3D knee model could be used in precise quantitative analysis and has excellent measurement accuracy and reliability 26 .…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Subgroup Analysis In Terms Of Sex Age and Heightmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…However, several studies have reported that this angle could not be increased excessively, for the tibial posterior wall may break and cause risk to the neurovascular bundles in the posterior popliteal fossa. 3,[21][22][23] Recently, Teng et al 10 have reported that the maximum tibial tunnel angle (ATP) for the anteromedial approach in transtibial PCL reconstruction is 58 .…”

Section: Anterolateral Approach Compared To Anteromedial Approachmentioning

confidence: 99%

“…Although previous studies have used cadaveric and biomechanical models to evaluate the killer turn angle, few studies quantitively analyzed this angle 7 . Due to the limitations of the cadaveric and biomechanical models, the effect of the varied tibial tunnel approach on the 3D killer turn angle is often not accurately analyzed 10 . Fortunately, a novel method of the 3D knee model establishes an in‐vitro virtual simulation technique, which provides great advantages in precise quantitative analysis and credible repeatability 11–13 .…”

Section: Introductionmentioning

confidence: 99%

3D Killer Turn Angle in Transtibial Posterior Cruciate Ligament Reconstruction Is Determined by the Graft Turning Angle both in the Sagittal and Coronal Planes

Jia

Tang

Liu

et al. 2022

Orthopaedic Surgery

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Objective During the transtibial posterior cruciate ligament (PCL) reconstruction, surgeons commonly pay more attention to the graft turning angle in the sagittal plane (GASP), but the graft turning angle in the coronal plane (GACP) is always neglected. This study hypothesized that the three‐dimensional (3D) killer turn angle was determined by both the GASP and GACP, and aimed to quantitively analyze the effects of the GASP and GACP on the 3D killer turn angle. Methods This was an in‐vitro computer simulation study of transtibial PCL reconstruction using 3D knee models. Patients with knee injuries who were CT scanned were selected from the CT database (April 2019 to January 2021) at a local hospital for reviewing. A total of 60 3D knees were simulated based on the knees' CT data. The femoral and tibial PCL attachment were located on the 3D knee model using the Rhinoceros software. The tibial tunnels were simulated based on different GASP and GACP. The effects of the GASP and GACP on the 3D killer turn angle were quantitatively analyzed. One‐way analysis of variance was used to compare the outcomes in different groups. The regression analysis was performed to identify variables of the GASP and GACP which significantly affected 3D killer turn angle. Results The 3D killer turn angle showed a significant proportional relationship not only with the GASP (r2 > 0.868, P < 0.001), but also with the GACP (r2 > 0.467, P < 0.001). Every 10° change of the GACP caused 2.8° to 4.4° change of the 3D killer turn angle, whereas every 10° change of the GASP caused 6.4° to 9.2° change of the 3D killer turn angle. Conclusions The 3D killer turn angle was significantly affected by both the GASP and GACP. During the transtibial PCL reconstruction, the proximal anterolateral tibial tunnel approach could increase the 3D killer turn angle more obviously compared with the most distal anteromedial tibial tunnel approach. To minimize the killer turn effect, both the GASP and GACP were required to be considered to increase.

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The tibial capsular reflection and septum in posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction

Niu,

Li,

Chen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate the validity of using tibial capsular reflection and septum in the posterior compartment as landmark during posterior cruciate ligament (PCL) reconstruction (PCLR).MethodsAnatomic measurements were obtained for 12 fresh human cadaveric knee specimens to observe the spatial position of the tibial insertion of the PCL in relation to the posterior septum and the capsular reflection in the posterior compartment. Sixty patients who underwent reconstruction of the PCL between 2020 and 2023 were also retrospectively investigated. The tibial tunnel was replaced in all patients using the same method (with reference to the tibial capsular reflection and the posterior septum). The placement of the tibial tunnel was assessed using X‐ray fluoroscopy intraoperatively and computed tomography and three‐dimensional reconstruction postoperatively.ResultsAll fibres in the tibial insertion of the PCL in the 12 cadaveric specimens were located in the posteromedial compartment, adjacent to the posterior septum. The inferior border of the PCL insertion is adjacent to the tibial capsular reflection, which is attached at the champagne glass drop‐off of the posterior tibia. In our previous cases, none of the patients experienced postoperative or intraoperative complications such as neurovascular injury, and the angle between the pin and the PCL facet was 93.1 ± 3.9° as measured on intraoperative radiographs. The mean distance from the centre of the tibial tunnel outlet to the inferior border of the PCL insertion was 5.6 ± 1.1 mm, and the distance from the centre of the tibial tunnel outlet to the outer border of the PCL insertion as a percentage of the length of the inferior border of PCL insertion was 42.2 ± 6.3%.ConclusionThe tibial capsular reflection and septum in the posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in PCLR.Level of EvidenceLevel Ⅳ.

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What Is the Maximum Tibial Tunnel Angle for Transtibial PCL Reconstruction? A Comparison Based on Virtual Radiographs, CT Images, and 3D Knee Models

Cited by 10 publications

References 35 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

3D Killer Turn Angle in Transtibial Posterior Cruciate Ligament Reconstruction Is Determined by the Graft Turning Angle both in the Sagittal and Coronal Planes

The tibial capsular reflection and septum in posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction

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