title: Consequences of tibial tunnel reaming on the meniscal roots during cruciate ligament reconstruction in a cadaveric model, Part 2: The posterior cruciate ligament.
abstract: BACKGROUND
  Recent emphasis has turned to reconstructing the posterior cruciate ligament (PCL) after injury. However, single-bundle PCL reconstruction of the anterolateral bundle may potentially injure the posterior meniscal roots.
  
  
  OBJECTIVE
  The purpose of this study was to determine if posterior meniscal root injuries occurred because of tunnel reaming for single-bundle PCL reconstruction. It was hypothesized that tibial tunnel reaming within the anterolateral bundle footprint during PCL reconstruction would result in clinically significant decreases in posteromedial (PM) root attachment areas and in ultimate failure strength for the PM root.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Testing was performed on 12 matched pairs of human cadaveric knees. For each pair of knees, one knee was left intact, while the contralateral knee was prepared with a tibial tunnel placed 5 mm anterior to the center of the tibial PCL attachment and within the previously described footprint of the anterolateral bundle of the PCL for single-bundle PCL reconstruction. The attachment areas of the posterior meniscal roots were measured with a coordinate measuring device before and after PCL tunnel reaming. The posterior meniscal roots were then pulled to failure with a dynamic tensile testing machine.
  
  
  RESULTS
  There was a significant mean decrease in the attachment area of the PM root (%Δ, 28%; 95% CI, 16-40) after PCL tunnel reaming compared with the intact state (P=.005). The mean ultimate failure strength of the native PM root (mean, 440 N; 95% CI, 347-534) was also significantly stronger (mean, 40%; 95% CI, 18-61; P=.005) than that of the PM root after PCL tunnel reaming (mean, 243 N; 95% CI, 176-309). No changes were found for the posterolateral (PL) root after PCL tunnel reaming.
  
  
  CONCLUSIONS
  Tibial tunnel reaming for single-bundle PCL reconstruction in the anterolateral bundle footprint significantly reduced the ultimate failure strength and attachment area of the PM meniscal root. The attachment area and ultimate failure strength of the PL root were unaffected by tunnel reaming.
  
  
  CONCLUSIONS
  Tibial tunnels reamed in the footprint of the anterolateral bundle during single-bundle PCL reconstruction can cause iatrogenic damage to the PM meniscal root attachment. Thus, tibial tunnels should strive to be reamed in the center of the entire tibial PCL attachment site during PCL reconstruction.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Smith
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rasmussen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hamming
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Feagin
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA rlaprade@thesteadmanclinic.com.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
mesh_terms: D001178:Arthroplasty / Q000009:adverse effects* / Q000379:methods; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007718:Knee Injuries / Q000209:etiology* / Q000503:physiopathology; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000503:physiopathology; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D013718:Tensile Strength; D013977:Tibia / Q000601:surgery*; D000070600:Tibial Meniscus Injuries
keywords: medial meniscus; meniscal roots; posterior cruciate ligament; posterior meniscal roots