Introduction: Accurate and reproducible tibial tunnel placement
minimizing the risk of neurovascular damage is a crucial condition
for successful arthroscopic reconstruction of the posterior cruciate
ligament (PCL). This step is commonly performed under fluoroscopic
control. Hypothesis: Performing the tibial tunnel under exclusive
arthroscopic control allows accurate and reliable tunnel placement
according to recommendations in the literature.
Materials and Methods: Between February 2007 and December
2009, 108 arthroscopic single bundle PCL reconstructions in tibial
tunnel technique were performed. The routine postoperative
radiographs were screened according to previously defined quality
criterions. After critical analysis, the radiographs of 48 patients (48
knees) were enrolled in the study. 10 patients had simultaneous ACL
reconstruction and 7 had PCL revision surgery. The tibial tunnel was
placed under direct arthroscopic control through a posteromedial
portal using a standard tibial aming device. Key anatomical landmarks
were the exposed tibial insertion of the PCL and the posterior horn
of the medial meniscus. First, the centre of the posterior tibial tunnel
outlet on the a-p view was determined by digital analysis of the
postoperative radiographes. Its distance to the medial tibial spine was
measured parallel to the tibia plateau. The mediolateral position was
expressed by the ratio between the distance of the tunnel outlet to the
medial border and the total width of the tibial plateau. On the lateral
view the vertical tunnel position was measured perpendicularly to a
tangent of the medial tibial plateau. All measurement were repeated
at least twice and carried out by two examiners.
Results: The mean mediolateral tunnel position was 49.3 ± 4.6%
(ratio), 6.7 ± 3.6 mm lateral to the medial tibial spine. On the lateral
view the tunnel centre was 10.1 ± 4.5 mm distal to the bony surface
of the medial tibial plateau. Neurovascular damage was observed in
none of our patients.
Conclusion: The results of this radiological study confirm that
exclusive arthroscopic control for tibial tunnel placement in PCL
reconstruction yields reproducible and accurate results according to
the literature. Our technique avoids radiation, facilitates the operation
room setting and enables the surgeon to visualize the anatomic key
landmarks for tibial tunnel placement.