The Journal of Bone and Joint Surgery (American). 2009;91:859-866.
doi:10.2106/JBJS.H.00991
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Morphology of the Tibial Insertion of the Posterior Cruciate Ligament

Goro Tajima, MD, PhD1, Masahiro Nozaki, MD2, Takanori Iriuchishima, MD, PhD3, Sheila J.M. Ingham, MD4, Wei Shen, MD, PhD4, Patrick Smolinski, PhD4 and Freddie H. Fu, MD4

1 Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan. E-mail address: gorot{at}iwate-med.ac.jp
2 Department of Orthopaedic Surgery, Nagoya City University, 1 Kawasumi Nizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
3 Department of Orthopaedic Surgery, Surugadai Nihon University Hospital, 1-8-13 Surugadai, Kanda, Chiyoda-ku, Tokyo 101-8309, Japan
4 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA 15213. E-mail address for F.H. Fu: ffu{at}upmc.edu

Investigation performed at the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Albert B. Ferguson, Jr., MD, Orthopaedic Fund of The Pittsburgh Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: It has been demonstrated that double-bundle reconstruction of the posterior cruciate ligament restores knee kinematics better than does single-bundle reconstruction. The objective of this study was to identify the tibial insertion site of the posterior cruciate ligament and the related osseous landmarks to help guide surgeons in the performance of an anatomical double-bundle reconstruction of the posterior cruciate ligament.

Methods: Twenty-one unpaired human cadaver knees were evaluated. The geometric data and surface features of the tibial insertion site of the posterior cruciate ligament and its bundles were studied with macroscopic observation and with three-dimensional laser photography.

Results: The mean surface areas (and standard deviations) of the anterolateral and posteromedial insertion sites were 93.1 ± 16.6 mm2 and 150.8 ± 31.0 mm2, respectively, and the distance between their centers was 8.2 ± 1.3 mm. The mean length and width of the anterolateral insertion site were 7.8 ± 1.5 mm and 9.2 ± 1.6 mm, and the mean length and width of the posteromedial insertion site were 9.4 ± 1.4 mm and 15.0 ± 2.7 mm. The average distances from the anterior and medial margins of the tibial plane to the center of the anterolateral insertion, defined as percentage ratios of the anteroposterior and mediolateral dimensions, were 83.4% ± 3.4% and 47.1% ± 1.9%, respectively, and the average distances from the anterior and medial margins of the tibial plane to the center of the posteromedial insertion were 95.5% ± 1.9% and 43.8% ± 2.2%. A notable change in angle, of >10°, was observed between the anterolateral and posteromedial slopes in sixteen of the twenty-one knees. The average angle between the anterolateral and posteromedial slopes was 14.5° ± 6.4°.

Conclusions: The tibial insertion site of the posterior cruciate ligament and its bundles is very complex. However, the shapes and positions of the insertion sites of the two bundles are consistent in that they are located in different planes on the posterior intercondylar fossa. We noted a consistent change in slope between the tibial insertion sites of the anterolateral and posteromedial bundles.

Clinical Relevance: The data from this study may improve our understanding of the anatomy of the posterior cruciate ligament attachments and may assist surgeons in performing reconstructive surgery in a more anatomical fashion.


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