title: Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position.
abstract: OBJECTIVE
  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.
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA. ealentorngeli@gmail.com.
authors.forename: Eduard
authors.initials: E
authors.lastname: Alentorn-Geli
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Stuart
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: James Choi
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Toth
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA.
authors.forename: Claude T
authors.initials: CT
authors.lastname: Moorman
authors.affiliation: Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, PO Box 3615, Durham, NC, 27710, USA.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology; D002102:Cadaver; D005260:Female; D005269:Femur; D000071976:Gracilis Muscle / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000033:anatomy & histology; D008875:Middle Aged; D010543:Peroneal Nerve / Q000033:anatomy & histology; D011150:Popliteal Artery; D016119:Posterior Cruciate Ligament / Q000033:anatomy & histology / Q000601:surgery*; D000072229:Posterior Cruciate Ligament Reconstruction / Q000379:methods*; D013710:Tendons / Q000033:anatomy & histology; D013977:Tibia / Q000033:anatomy & histology / Q000601:surgery*
keywords: Posterior cruciate ligament; Posterolateral portal; Safety; Tibial drilling