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Current Reviews in Musculoskeletal Medicine

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01-09-2018 | PCL Update (K Jones and M Alaia, section editors)

Posterior Cruciate Ligament: Anatomy and Biomechanics

Authors: Stephanie L. Logterman, Frank B. Wydra, Rachel M. Frank

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2018

Abstract

Purpose of Review

The purpose of this review is to present an in-depth look at the most recent literature regarding pertinent posterior cruciate ligament (PCL) anatomy and biomechanics.

Recent Findings

The PCL is an important restraint of posterior tibial translation relative to the femur. In addition, the PCL acts as a secondary restraint to resist varus, valgus, and external rotation moments about the knee. While less common than ACL injuries, injuries to the PCL can occur from a posterior force directed on the tibia, most common with the knee in a flexed position.

Summary

The PCL is composed of two functional bundles and has important implications for knee stability. The anterolateral and posteromedial bundles have different patterns of tensioning throughout knee range of motion. The two bundles therefore contribute to resisting posterior tibial translation and rotation at different angles of knee flexion.

Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res. 1975;106(106):216–31.CrossRef

Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL. Quantitative analysis of human cruciate ligament insertions. Arthroscopy. 1999;15(7):741–9. https://doi.org/10.1016/S0749-8063(99)70006-X.CrossRefPubMed

Voos JE, Md Y, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament anatomy, biomechanics, and outcomes. https://doi.org/10.1177/0363546511416316.

Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. Am J Sports Med. 2013; https://doi.org/10.1177/0363546512465072.

Forsythe B, Harner C, Martins CA, Shen W, Lopes OV, Fu FH. Topography of the femoral attachment of the posterior cruciate ligament. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2(Part 1)):89–100. https://doi.org/10.2106/JBJS.H.01514.CrossRefPubMed

Edwards A, Bull AM, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(3):284–90. https://doi.org/10.1016/j.arthro.2006.11.005.CrossRefPubMed

Matava MJ, Ellis E, Gruber B. Surgical treatment of posterior cruciate ligament tears: an evolving technique. J Am Acad Orthop Surg. 2009;17(7):435–46.CrossRefPubMed

Moorman CT, Murphy Zane MS, Bansai S, et al. Tibial insertion of the posterior cruciate ligament: a sagittal plane analysis using gross, histologic, and radiographic methods. Arthrosc - J Arthrosc Relat Surg. 2008;24(3):269–75. https://doi.org/10.1016/j.arthro.2007.08.032.CrossRef

Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat. 1997;10(3):151–62. https://doi.org/10.1002/(SICI)1098-2353(1997)10:3<151::AID-CA1>3.0.CO;2-X.CrossRefPubMed

10.

Osti M, Tschann P, Md Y, Kü KH, Benedetto KP. Anatomic characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. Am J Sports Med. 2012; https://doi.org/10.1177/0363546512445166.

11.

• Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Jt Surg Am. 2012;94(21):1936–45. https://doi.org/10.2106/JBJS.K.01710. This reference is important as it nicely shows the arthroscopic anatomy of the PCL, which is helpful for surgeons performing PCL reconstruction. CrossRef

12.

Takahashi M, Doi M, Abe M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med. 2006;34(5):787–92. https://doi.org/10.1177/0363546505282625.CrossRefPubMed

13.

Morgan CD, Kalman VR, Grawl DM. The anatomic origin of the posterior cruciate ligament: where is it? Reference landmarks for PCL reconstruction. Arthroscopy. 1997;13(3):325–31. https://doi.org/10.1016/S0749-8063(97)90029-3.CrossRefPubMed

14.

• Kramer DE, Bahk MS, Totty WG, Matava MJ, Cosgarea AJ. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy. J Knee Surg. 2006;19(3):181–5. https://doi.org/10.1055/s-0030-1248103. This reference is important to highlight the anatomy of several relevant neurovascular structures in proximity to the PCL, which is helpful for surgeons performing PCL reconstruction. PubMedCrossRef

15.

Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy. 2000;16(8):796–804. https://doi.org/10.1053/jars.2000.18243.CrossRefPubMed

16.

LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med. 2015; https://doi.org/10.1177/0363546515572770.

17.

Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament: a review. Am J Sports Med. 1989;17(1):24–9. https://doi.org/10.1177/036354658901700104.CrossRefPubMed

18.

Ahmad CS, Cohen ZA, Levine WN, Gardner TR, Ateshian GA, Mow VC. Codominance of the individual posterior cruciate ligament bundles. An analysis of bundle lengths and orientation. Am J Sports Med. 2003;31(2):221–5. https://doi.org/10.1364/JOSAB.24.001771.CrossRefPubMed

19.

Kennedy NI, LaPrade RF, Goldsmith MT, et al. Posterior cruciate ligament graft fixation angles, part 2: biomechanical evaluation for anatomic double-bundle reconstruction. https://doi.org/10.1177/0363546514541226.

20.

Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000;28(2):144–51. http://www.ncbi.nlm.nih.gov/pubmed/10750988 CrossRefPubMed

21.

Papannagari R, DeFrate LE, Nha KW, et al. Function of posterior cruciate ligament bundles during in vivo knee flexion. Am J Sports Med. 2007;35(9):1507–12. https://doi.org/10.1177/0363546507300061.CrossRefPubMed

22.

Kennedy NI, LaPrade RF, Goldsmith MT, et al. Posterior cruciate ligament graft fixation angles, part 1: biomechanical evaluation for anatomic single-bundle reconstruction. https://doi.org/10.1177/0363546514541225.

23.

Gollehon DL, Torzilli PA, Warren RF. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am. 1987;69(2):233–42. https://doi.org/10.1177/036354659502300411.CrossRefPubMed

24.

Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am. 1988;70(1):88–97.CrossRefPubMed

25.

Fox RJ, Harner CD, Sakane M, Carlin GJ, Woo SL-Y. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology: a cadaveric study. Am J Sport Med. 1998;26(3):395–401.CrossRef

26.

Li G, Gill TJ, DeFrate LE, Zayontz S, Glatt V, Zarins B. Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study. J Orthop Res. 2002;20(4):887–92. https://doi.org/10.1016/S0736-0266(01)00184-X.CrossRefPubMed

27.

Gill TJ, DeFrate LE, Wang C, et al. The biomechanical effect of posterior cruciate ligament reconstruction on knee joint function. Kinematic response to simulated muscle loads. Am J Sports Med. 2003;31(4):530–6.CrossRefPubMed

28.

Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res. 1976:263–70. https://doi.org/10.1097/00003086-197606000-00034.

29.

Marinozzi G, Pappalardo S, Steindler R. Human knee ligaments: mechanical tests and ultrastructural observations. Ital J Orthop Traumatol. 1983;9(2):231–40. http://www.ncbi.nlm.nih.gov/pubmed/6654659 PubMed

30.

Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am. 1976;58(3):350–5. http://www.ncbi.nlm.nih.gov/pubmed/1262366 CrossRefPubMed

31.

Butler DL, Kay MD, Stouffer DC. Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. J Biomech. 1986;19(6):425–32. https://doi.org/10.1016/0021-9290(86)90019-9.CrossRefPubMed

32.

Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 1994;27(1):13–24. https://doi.org/10.1016/0021-9290(94)90028-0.CrossRefPubMed

33.

Amis AA, Bull AMJ, Gupte CM, Hijazi I, Race A, Robinson JR. Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc. 2003;11(5):271–81. https://doi.org/10.1007/s00167-003-0410-7.CrossRefPubMed

Title: Posterior Cruciate Ligament: Anatomy and Biomechanics
Authors: Stephanie L. Logterman
Frank B. Wydra
Rachel M. Frank
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 3/2018
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9492-1

At a glance: The STEP trials

Springer Medicine

Posterior Cruciate Ligament: Anatomy and Biomechanics

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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