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.

Autor: Niu Y; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China., Li Z; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China., Chen Z; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China., Zheng Y; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China., Zhang Z; Department of Orthopaedic Surgery, Tiemenguan People's Hospital, Xinjiang, China., Zhang Z; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China., Ma J; Department of Hebei Medical University, Shijiazhuang, China., Dong J; Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2024 Jul; Vol. 32 (7), pp. 1682-1689. Date of Electronic Publication: 2024 Apr 23.
DOI: 10.1002/ksa.12202
Abstrakt: Purpose: To investigate the validity of using tibial capsular reflection and septum in the posterior compartment as landmark during posterior cruciate ligament (PCL) reconstruction (PCLR).
Methods: Anatomic 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.
Results: All 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%.
Conclusion: The tibial capsular reflection and septum in the posterior compartment are safe and reliable soft-tissue landmark for tibial tunnel drilling in PCLR.
Level of Evidence: Level Ⅳ.
(© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
Databáze: MEDLINE
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