Lorenz Stephan, Elser Florian, Brucker Peter U, Obst Tobias, Imhoff Andreas B
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Connollystr. 32, 80809, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2009 Jun;17(6):683-90. doi: 10.1007/s00167-009-0770-8. Epub 2009 Mar 24.
The optimal technique of posterior cruciate ligament (PCL) reconstruction is still controversial. Besides different parameters as surgical technique and graft choice, the exact anatomic placement of the graft is essential for successful reconstruction of the PCL. For intraoperative control and postoperative radiological evaluation of the anatomical placement of the anterolatelateral (ALB) and posteromedial bundle (PMB) of the PCL, the radiological localization of both functional bundles of the PCL has yet to be determined. Therefore, in this descriptive laboratory study, the insertion sites of the ALB and PMB of the PCL on the femur and the common tibial insertion site were macroscopically identified and marked with copper wires in 16 human cadaver specimens. Radiological evaluation of the femoral insertion sites of the ALB and PMB in AP full extension and true lateral radiography was performed using an angle segment transformation based on the tangent of the femoral condyles and a modified reticule system of the quadrant method, respectively. On the tibial site, the footprint of the PCL was defined as ratios of the geometric insertion site with respect to the mediolateral and sagittal diameter of the tibia in AP and true lateral radiography. Femorally, the geometric insertion points of the ALB and PMB were located on the reticule at x = 62 +/- 3%/y = 16 +/- 6% and x = 51 +/- 5%/y = 35 +/- 7%, respectively; the angle segments for the PMB were between 40 +/- 5 degrees and 56 +/- 6 degrees and for the ALB were between 56 +/- 6 degrees and 76 +/- 7 degrees. Tibially, the common insertion point of the PCL was located at 51 +/- 2% of the mediolateral diameter of the tibial plateau with respect to the lateral border and 13 +/- 2% inferiorly to the medial tibial plateau with respect to the sagittal diameter of the tibial plateau. In conclusion, the knowledge of the anatomical insertion sites of the PCL in standardized radiography may help the orthopaedic surgeon for correct intraoperative placement and postoperative evaluation of the tunnel placement. In addition, the data might be a useful tool for fluoroscopic-based navigation in PCL reconstruction.
后交叉韧带（PCL）重建的最佳技术仍存在争议。除了手术技术和移植物选择等不同参数外，移植物的确切解剖位置对于PCL的成功重建至关重要。对于PCL前外侧束（ALB）和后内侧束（PMB）解剖位置的术中控制和术后影像学评估，PCL两个功能束的影像学定位尚未确定。因此，在这项描述性实验室研究中，在16具人体尸体标本上宏观识别并标记了PCL的ALB和PMB在股骨上的附着点以及常见的胫骨附着点，并使用铜丝进行标记。分别基于股骨髁切线的角度段变换和象限法的改良标线系统，对ALB和PMB在股骨附着点进行前后位完全伸直位和真正侧位X线摄影的影像学评估。在胫骨部位，PCL的足迹通过在前后位和真正侧位X线摄影中，几何附着点相对于胫骨内外侧和矢状径的比例来定义。在股骨上，ALB和PMB的几何附着点分别位于标线的x = 62±3%/y = 16±6%和x = 51±5%/y = 35±7%处；PMB的角度段在40±5度至56±6度之间，ALB的角度段在56±6度至76±7度之间。在胫骨上，PCL的共同附着点位于胫骨平台外侧缘内外侧径的51±2%处，相对于胫骨平台矢状径，位于胫骨内侧平台下方13±2%处。总之，了解PCL在标准化影像学中的解剖附着点，可能有助于骨科医生在术中正确放置以及术后评估隧道位置。此外，这些数据可能是PCL重建中基于荧光透视导航的有用工具。
