MRI analysis of tibial PCL attachment in a large population of adult patients: reference data for anatomic PCL reconstruction.
Consistent reference data used for anatomic posterior cruciate ligament (PCL) reconstruction is not well defined. Quantitative guidelines defining the location of PCL attachment would aid in performing anatomic PCL reconstruction. The purpose was to characterize anatomic parameters of the PCL tibial attachment based on magnetic resonance imaging (MRI) in a large population of adult knees.



The PCL tibial attachment site was examined in 736 adult knees with an intact PCL using 3.0-T proton density-weighted sagittal MRI. The outcomes measured were the anterior-posterior diameter (APD) of the tibial plateau; angle between the tibial plateau and the posterior tibial 'shelf' (the slope where the PCL tibial attachment site was) (PTS); length of the PTS; proximal, central, and distal PCL attachment positions as well as the width of the PCL attachment site; and vertical dimension of the PCL attachment site inferior from the tibial plateau.



The average APD of the tibia plateau was 33.6 ± 3.5 mm, yielding significant differences between males (35.5 ± 3.0 mm) and females (31.6 ± 2.7 mm), P <.05, and there was a significantly decreasing trend with increasing age in males (P <.05). Mean angle between the tibial plateau and the PTS was 122.4° ± 8.1°, and subgroup analysis showed that the young group had a differently smaller angle (120.9° ± 7.5°) than the middle-aged (123.7° ± 8.2°) and the old (123.4° ± 7.7°) in males population, while there were no significant differences between sexes (P >.05). The proximal, central positions and width of the PCL attachment site were 13.4 ± 3.0 mm, 17.8 ± 3.0 mm and 9.6 ± 2.4 mm along the PTS, with significant differences between males and females (P <.05), and accounted for 60.0 % ± 9.1 %, 80.0 % ± 4.6 % and 43.3 % ± 9.7 % of the PTS respectively, with no significant differences between sexes and among age groups (all P >.05).



This study provides reference data of the tibial PCL attachment based on MRI in the sagittal orientation. In analysis of retrospective data from a large population of adult patients, the quantitative values can be used as references to define the inserted angle and depth of the drill guide, and the exact position and size of the tibial PCL tunnel for performing arthroscopic anatomic PCL reconstruction.
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.
Yuanjun
Y
Teng
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.|Orthopaedics Key Laboratory of Gansu Province, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou City, Gansu Province, 730030, China.
Laiwei
L
Guo
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China. wumeng0330@163.com.
Meng
M
Wu
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.|Orthopaedics Key Laboratory of Gansu Province, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou City, Gansu Province, 730030, China.
Tianen
T
Xu
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.
Lianggong
L
Zhao
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.|Orthopaedics Key Laboratory of Gansu Province, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou City, Gansu Province, 730030, China.
Jin
J
Jiang
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.
Xiaoyun
X
Sheng
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.
Lihu
L
Xu
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.|Orthopaedics Key Laboratory of Gansu Province, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou City, Gansu Province, 730030, China.
Bo
B
Zhang
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.|Orthopaedics Key Laboratory of Gansu Province, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou City, Gansu Province, 730030, China.
Ning
N
Ding
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou City, No. 82 Cuiyingmen, Chengguan District, Lanzhou City, Gansu Province, 730030, China.
Yayi
Y
Xia
D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D012016:Reference Values; D055815:Young Adult
Magnetic resonance imaging; PCL reconstruction; Posterior cruciate ligament; Reference data