Transtibial Tunnel Placement in Posterior Cruciate Ligament Reconstruction - How it Relates to the Anatomic Footprint

Article
Authors:Hart, Joseph, Department of KinesiologyUniversity of Virginia Tompkins, Mark, Orthopaedic SurgeryUVA Keller, Tom, Orthopaedic SurgeryUVA Milewski, Matt, Orthopaedic SurgeryUVA Gaskin, Christopher, RadiologyBrockmeier, Stephen, Orthopaedic SurgeryUVA Miller, Mark, Orthopaedic SurgeryUVA
Abstract:

Abstract
BACKGROUND:
It is common to place the posterior cruciate ligament (PCL) tibial tunnel with a transtibial technique using a guide that attempts to place the center of the tunnel 1 to 1.5 cm distal to the tibiofemoral joint. It is unknown how well this technique will re-create the native tibial footprint of the PCL.
PURPOSE:
To evaluate the accuracy of tibial tunnel placement using a transtibial technique.
STUDY DESIGN:
Controlled laboratory study.
METHODS:
Ten cadaveric knees from 10 donors underwent arthroscopic transtibial drilling of the tibial tunnel with use of a posteromedial portal for visualization. The transtibial guide was rested flush against the tibial spines to allow for the guide to be as distal as possible, which was between 1 and 1.5 cm distal to the tibiofemoral joint line. Using this technique, an attempt was made to place the tibial tunnels as close to the center of the PCL footprint as possible. All knees underwent computed tomography both pre- and postoperatively with a previously reported technique optimized for ligament evaluation. This allowed comparison of the anatomic PCL tibial footprint to the tibial tunnel aperture. The percentage of tunnel aperture contained within the native footprint as well as the distance from the center of the tunnel aperture to the center of the footprint was measured.
RESULTS:
The percentage of tunnel aperture contained within the native footprint was 45.9% ± 23.1%. The distance from the center of the tibial tunnel aperture to the center of the tibial PCL footprint was 6.4 ± 2.3 mm. The tunnels were almost always (9/10) distal (or inferior) to the native footprint and either slightly lateral (5/10) or centered (5/10) in a medial to lateral direction.
CONCLUSION:
This study demonstrates that using the transtibial drilling technique in the tibia for PCL reconstruction places approximately half of the tibial tunnel aperture within the tibial footprint. Generally, the tunnel is distal to the footprint.
CLINICAL RELEVANCE:
Consideration should be given to the fact that, using this transtibial technique, the tibial tunnel aperture is generally not placed in the center of the footprint. This may not be a negative issue, however, since there are other potential advantages from distal tunnel placement.

Keywords:
PCL reconstruction, tibial footprint, tibial tunnel, transtibial
Rights:
All rights reserved (no additional license for public reuse)
Language:
English
Source Citation:

Hart, Joseph, Mark Tompkins, Tom Keller, Matt Milewski, Christopher Gaskin, Stephen Brockmeier, and Mark Miller. "Transtibial Tunnel Placement in Posterior Cruciate Ligament Reconstruction - How it Relates to the Anatomic Footprint." Orthopaedic Journal of Sports Medicine 2.2 (2014): 1-6. Available: ["https://www.ncbi.nlm.nih.gov/pubmed/26535303"].

Publisher:
Sage
Published Date:
2014
Sponsoring Agency:
University of Virginia
Notes:

This work has passed a peer-review process.