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Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position.

Publication ,  Journal Article
Alentorn-Geli, E; Stuart, JJ; James Choi, JH; Toth, AP; Moorman, CT; Taylor, DC
Published in: Knee Surg Sports Traumatol Arthrosc
August 2017

PURPOSE: To evaluate the safety for neurovascular structures and accuracy for tunnel placement of the posterolateral portal tibial tunnel drilling technique in posterior cruciate ligament (PCL) reconstruction. METHODS: Fifteen fresh-frozen human cadaveric knees were used. The tibial tunnel for the PCL was created using a flexible reamer from the posterolateral portal. Then, the flexible pin was left in place, and the distance from the posterolateral portal, the flexible pin, and the tibial tunnel to the peroneal nerve and popliteal artery was measured. Additionally, the distance between the tibial tunnel and several landmarks related to the PCL footprint was measured, along with the distance from the exit point of the flexible pin to the superficial medial collateral ligament and gracilis tendon. RESULTS: The peroneal nerve and the popliteal neurovascular bundle were not damaged in any of the specimens. The median (range) distance in mm from the peroneal nerve and popliteal artery to the posterolateral portal and flexible pin was: 52 (40-80) and 50 (40-61), and 35 (26-51) and 22 (16-32), respectively. The median (range) distance from the tibial tunnel to the popliteal artery was 21 mm (15-38). The tibial tunnel was located at a median (range) distance in mm of 3 (2-6), 6 (3-12), 5 (2-7), 4 (1-8), 9 (3-10), 10 (4-19), and 19 (6-24) to the champagne-glass drop-off, lateral cartilage point, shiny white fibre point, medial groove, medial meniscus posterior root, lateral meniscus posterior root, and posterior aspect of the anterior cruciate ligament, respectively. CONCLUSIONS: The posterolateral portal tibial tunnel technique is safe relative to neurovascular structures and creates an anatomically appropriate tibial tunnel location. The clinical relevance of study is that this technique may be safely and accurately used in PCL reconstruction to decrease the risk of neurovascular damage (avoid use of a posteriorly directed pin), avoid the use of intraoperative fluoroscopy, and avoid the sharp turn during graft passage.

Duke Scholars

Published In

Knee Surg Sports Traumatol Arthrosc

DOI

EISSN

1433-7347

Publication Date

August 2017

Volume

25

Issue

8

Start / End Page

2474 / 2480

Location

Germany

Related Subject Headings

  • Tibia
  • Tendons
  • Posterior Cruciate Ligament Reconstruction
  • Posterior Cruciate Ligament
  • Popliteal Artery
  • Peroneal Nerve
  • Orthopedics
  • Middle Aged
  • Menisci, Tibial
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Alentorn-Geli, E., Stuart, J. J., James Choi, J. H., Toth, A. P., Moorman, C. T., & Taylor, D. C. (2017). Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position. Knee Surg Sports Traumatol Arthrosc, 25(8), 2474–2480. https://doi.org/10.1007/s00167-015-3958-0
Alentorn-Geli, Eduard, Joseph J. Stuart, J. H. James Choi, Alison P. Toth, Claude T. Moorman, and Dean C. Taylor. “Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position.Knee Surg Sports Traumatol Arthrosc 25, no. 8 (August 2017): 2474–80. https://doi.org/10.1007/s00167-015-3958-0.
Alentorn-Geli E, Stuart JJ, James Choi JH, Toth AP, Moorman CT, Taylor DC. Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position. Knee Surg Sports Traumatol Arthrosc. 2017 Aug;25(8):2474–80.
Alentorn-Geli, Eduard, et al. “Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position.Knee Surg Sports Traumatol Arthrosc, vol. 25, no. 8, Aug. 2017, pp. 2474–80. Pubmed, doi:10.1007/s00167-015-3958-0.
Alentorn-Geli E, Stuart JJ, James Choi JH, Toth AP, Moorman CT, Taylor DC. Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position. Knee Surg Sports Traumatol Arthrosc. 2017 Aug;25(8):2474–2480.
Journal cover image

Published In

Knee Surg Sports Traumatol Arthrosc

DOI

EISSN

1433-7347

Publication Date

August 2017

Volume

25

Issue

8

Start / End Page

2474 / 2480

Location

Germany

Related Subject Headings

  • Tibia
  • Tendons
  • Posterior Cruciate Ligament Reconstruction
  • Posterior Cruciate Ligament
  • Popliteal Artery
  • Peroneal Nerve
  • Orthopedics
  • Middle Aged
  • Menisci, Tibial
  • Male