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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2014

Open Access 01-07-2014 | Knee

Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review

Authors: J.-D. Nicodeme, C. Löcherbach, B. M. Jolles

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2014

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Abstract

Purpose

Reconstruction of the posterior cruciate ligament (PCL) yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. Accurate tibial tunnel placement is crucial for successful PCL reconstruction using arthroscopic tibial tunnel techniques. A discrepancy between anatomical studies of the tibial PCL insertion site and surgical recommendations for tibial tunnel placement remains. The objective of this study was to identify the optimal placement of the tibial tunnel in PCL reconstruction based on clinical studies.

Methods

In a systematic review of the literature, MEDLINE, EMBASE, Cochrane Review, and Cochrane Central Register of Controlled Trials were screened for articles about PCL reconstruction from January 1990 to September 2011. Clinical trials comparing at least two PCL reconstruction techniques were extracted and independently analysed by each author. Only studies comparing different tibial tunnel placements in the retrospinal area were included.

Results

This systematic review found no comparative clinical trial for tibial tunnel placement in PCL reconstruction. Several anatomical, radiological, and biomechanical studies have described the tibial insertion sites of the native PCL and have led to recommendations for placement of the tibial tunnel outlet in the retrospinal area. However, surgical recommendations and the results of morphological studies are often contradictory.

Conclusions

Reliable anatomical landmarks for tunnel placement are lacking. Future randomized controlled trials could compare precisely defined tibial tunnel placements in PCL reconstruction, which would require an established mapping of the retrospinal area of the tibial plateau with defined anatomical and radiological landmarks.

Level of evidence

III.
Appendix
Available only for authorised users
Literature
1.
Ahn JH, Yoo JC, Wang JH (2005) Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft–clinical results of a minimum 2-year follow-up. Arthroscopy 21:965–969CrossRefPubMed
2.
Badet R, Siegrist O (2004) Techniques de reconstruction du ligament croisé postérieur. In: Neyret P (ed) Ligaments croisés du Genou: Cahiers d’enseignement de la Sofcot no 86. Elsevier Masson, Issy-les-Moulineaux, pp 183–193
3.
4.
Bomberg BC, Acker JH, Boyle J (1990) The effect of posterior cruciate ligament loss and reconstruction on the knee. Am J Knee Surg 3:85–96
5.
Chen CH, Chen WJ, Shih CH (2002) Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 18:603–612CrossRefPubMed
6.
Christel P, Branfraux M, Djian P (2003) Traitement chirurgical des lésions du ligament croisé postérieur. In: Landreau P, Christel P, Djian P (eds) Pathologie ligamentaire du genou. Springer, France, pp 475–498
7.
Clancy WG Jr, Shelbourne KD, Zoellner GB, Keene JS, Reider B, Rosenberg TD (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg Am 65:310–322PubMed
8.
Cosgarea AJ, Jay PR (2001) Posterior cruciate ligament injuries: evaluation and management. J Am Acad OrthopSurg 9:297–307
9.
Edwards A, Bull AM, Amis AA (2007) The attachments of the fibber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23:284–290CrossRefPubMed
10.
Fanelli GC (2001) Arthroscopically assisted posterior cruciate ligament reconstruction: transtibial tunnel technique. In: Fanelli GC (ed) Posterior cruciate ligament injuries—a practical guide to management. Springer, New York, pp 141–156CrossRef
11.
Freeman RT, Duri ZA, Dowd GS (2002) Combined chronic posterior cruciate and posterolateral corner ligamentous injuries: a comparison of posterior cruciate ligament reconstruction with and without reconstruction of the posterolateral corner. Knee 9:309–312CrossRefPubMed
12.
Galloway MT, Grood ES, Mehalik JN, Levy M, Saddler SC, Noyes FR (1996) Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement. Am J Sports Med 24:437–445CrossRefPubMed
13.
Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231CrossRefPubMed
14.
Greiner P, Magnussen RA, Lustig S, Demey G, Neyret P, Servien E (2011) Computed tomography evaluation of the femoral and tibial attachments of the posterior cruciate ligament in vitro. Knee Surg Sports Traumatol Arthrosc 19:1876–1883CrossRefPubMed
15.
Harner CD, Hoher J (1998) Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 26:471–482PubMed
16.
Hatayama K, Higuchi H, Kimura M, Kobayashi Y, Asagumo H, Takagishi K (2006) A comparison of arthroscopy single-and double-bundle posterior cruciate ligament reconstruction: review of 20 cases. Am J Orthop (Belle Mead NJ) 35:568–571
17.
Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF (2013) Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstrunction. Am J Sports Med 41:35–42CrossRefPubMed
18.
Jung YB, Jung HJ, Kim SJ, Park SJ, Song KS, Lee YS, Lee SH (2008) Posterolateral corner reconstruction for posterolateral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques. Knee Surg Sports Traumatol Arthrosc 16:239–248CrossRefPubMed
19.
Kantaras A, Johnson D (2002) The medial meniscal root as a landmark for tibial tunnel position in the posterior cruciate ligament reconstruction. Arthroscopy 18:99–101CrossRefPubMed
20.
Kim SJ, Kim TE, Jo SB, Kung YP (2009) Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques. J Bone Joint Surg Am 91:2543–2549CrossRefPubMed
21.
Kim SJ, Shin SJ, Kim HK, Jahng JS, Kim HS (2000) Comparison of 1- and 2-incision posterior cruciate ligament reconstructions. Arthroscopy 16:268–278CrossRefPubMed
22.
Li B, Wen Y, Wu H, Qian Q, Wu Y, Lin X (2009) Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament. Int Orthop 33:991–996PubMedCentralCrossRefPubMed
23.
Lipscomb AB Jr, Anderson AF, Norwig ED, Hovis WD, Brown DL (1993) Isolated posterior cruciate ligament reconstruction. Long-term results. Am J Sports Med 21:490–496CrossRefPubMed
24.
Lorenz S, Elser F, Brucker PU, Obst T, Imhoff AB (2009) Radiological evaluation of the anterolateral and posteromedial bundle insertion sites of the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 17:683–690CrossRefPubMed
25.
MacGillivray JD, Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 22:320–328CrossRefPubMed
26.
Markolf KL, McAllister DR, Young CR, McWilliams J, Oakes DA (2003) Biomechanical effects of medial-lateral tibial tunnel placement in posterior cruciate ligament reconstruction. J Orthop Res 21:177–182CrossRefPubMed
27.
Markolf KL, Feeley BT, Jackson SR, McAllister DR (2006) Where should the femoral tunnel of a posterior cruciate ligament reconstruction be placed to best restore anteroposterior laxity and ligament forces? Am J Sports Med 34:604–611CrossRefPubMed
28.
Moorman CT, Murphy Zane MS, Bansai S, Cina SJ, Wickiewicz TL, Warren RF, Kaseta MK (2008) Tibial insertion of the posterior cruciate ligament: a sagittal plane analysis using gross, histologic, and radiographic methods. Arthroscopy 24:269–275CrossRefPubMed
29.
Noyes F, Barber-W S, Grood E (2001) Newer concept of the treatment of posterior cruciate ligament ruptures. In: Insall JN, Scott WN (eds) Surgery of the knee, 3rd edn. Churchill Livingstone, New York, pp 841–878
30.
Osti M, Tschann P, Kunzel KH, Benedetto KP (2012) Anatomic characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. Am J Sports Med 40:1558–1563CrossRefPubMed
31.
Park SE, Stamos BD, DeFrate LE, Gill TJ, Li G (2004) The effect of posterior knee capsulotomy on posterior tibial translation during posterior cruciate ligament tibial inlay reconstruction. Am J Sports Med 32:1514–1519CrossRefPubMed
32.
Racanelli JA, Drez D Jr (1994) Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction. Arthroscopy 10:546–549CrossRefPubMed
33.
Ramos LA, de Carvalho RT, Cohen M, Abdalla RJ (2008) Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy 24:1367–1372CrossRefPubMed
34.
Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD (2005) Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy 21:1042–1050CrossRefPubMed
35.
Sheps DM, Otto D, Fernhout M (2005) The anatomic characteristics of the tibial insertion of the posterior cruciate ligament. Arthroscopy 21:820–825CrossRefPubMed
36.
Strobel MJ (2001) Posterior Cruciate Ligament. In: Strobel M (ed) Manual of arthroscopic surgery. Springer, Berlin, pp 571–641
37.
Tajima G, Nozaki M, Iriuchishima T, Ingham SJ, Shen W, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866CrossRefPubMed
38.
Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:1055–1059
39.
Van Dommelen BA, Fowler PJ (1989) Anatomy of the posterior cruciate ligament. A review. Am J Sports Med 17:24–29CrossRefPubMed
40.
Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL (2012) Posterior cruciate ligament anatomy, biomechanics, and outcomes. Am J Sports Med 40:222–231CrossRefPubMed
41.
Wang CJ, Chan YS, Weng LH, Yuan LJ, Chen HS (2004) Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury 35:1279–1285CrossRefPubMed
42.
Wang CJ, Weng LH, Hsu CC, Chan YS (2004) Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft. Injury 35:1293–1299CrossRefPubMed
43.
Wong T, Wang CJ, Weng LH, Hsu SL, Chou WY, Chen JM, Chan YS (2009) Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach. Arch Orthop Trauma Surg 129:315–321CrossRefPubMed
Metadata
Title
Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review
Authors
J.-D. Nicodeme
C. Löcherbach
B. M. Jolles
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2563-3

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