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SA Orthopaedic Journal

versión On-line ISSN 2309-8309
versión impresa ISSN 1681-150X

SA orthop. j. vol.8 no.4 Pretoria ene. 2009

 

REVIEW ARTICLE

 

Anatomy of the posterior cruciate ligament

 

 

JJ Marais

MBChB, MMed(Orth)(Stel); Durbanville Medi-Clinic

Correspondence

 

 


ABSTRACT

The indication for surgery in isolated posterior cruciate ligament (PCL) rupture remains unclear. Although conservative treatment seems to be compatible with good functional outcome in the short and medium term, surgery seems to improve the subjective outcome in symptomatic patients.1
Because as a principle 'form follows function' understanding the anatomy is both important in clinical examination and the subsequent decision to treat the PCL rupture conservatively or surgically. For the purpose of this paper I did a literature review as well as a fresh cadaveric dissection in order to search for the relevant biomechanical and anatomical factors of importance when embarking on surgical reconstruction. I hope that it will help surgeons to simplify the surgical anatomy. Better knowledge of the anatomy will improve the quality of reconstruction as in the case of anterior cruciate ligament repairs.


 

 

“Full text available only in PDF format”

 

 

References

1. Walters J. Isolated posterior cruciate ligament injury : does surgery improve the outcome? A discussion of the literature. SA Orthopaedic Journal 2006 Feb;5(1):8-14.         [ Links ]

2. Kumagai M, Mizumo Y, Matteschi SM, Elias JJ, Cosgarca AJ, Chao EY. Posterior cruciate ligament rupture alters in vivo knee kinematics. Clin Orthop 2002;345:241-8.         [ Links ]

3. Vogrin T, Giffen JR, Woo SL, Fu FH, Harner CD. Biomechanics of the posterior cruciate deficient knee. Techniques in knee surgery 2001;16(2):109-18.         [ Links ]

4. Race A, Amis AA. Loading of the two bundles of the posterior cruciate ligament: An analysis of bundle function in AP drawer. J Biomech 1996;29:873-9.         [ Links ]

5. Sekiya JK, Whiddon DR, Zehms CT, Miller MD. A clinical relevant assessment of posterior cruciate ligament and posterolateral corner injuries. Evaluation of isolated and combined deficiency. J Bone Joint Surg (Am) 2008;90:1621-7.         [ Links ]

6. Le Prade RF, Tso A. Force measurement on fibular collateral ligament, popliteofibular ligament and popliteus tendon to applied loads. Am J Sports Med 2004;32:1695-701.         [ Links ]

7. Mauro CS, Sekiya JK, Stabile KJ, Haemmerle MJ, Harner CD. Double bundle PCL and posterolateral corner reconstruction components are codominant. Clin Orthop 2008;466:2247-5.         [ Links ]

8. Goodes ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg (Am) 1988;70:88-97.         [ Links ]

9. Davis DK, Goltz DH, Fithian DC, D'Limia D. Anatomical posterior cruciate ligament transplantation. A biomechanical analysis. Am J Sports Med 2006; 34:1126-33.         [ Links ]

10. Shybar MJ, Warren RP The effect of sectioning the posterior cruciate ligament and posterolateral complex on the articular contact pressure within the knee. J Bone Joint Surg (Am) 1993;75:694-9.         [ Links ]

11. Harner CD, Xerogeanes JW, Livesay GA, Carlin GJ, Smith BA, Kusaiyama T, Kashivraguchi S, Woo SL. The human posterior cruciate ligament complex: An interdisciplinary study. Am J Sports Med 1995;23:736-45.         [ Links ]

12. Makris CA, Georgoulis AD, Papageorgion CP, Saucacos PN. Posterior cruciate ligament architecture: Evaluation under microsurgical dissection. Arthroscopy 2000; 16(6):627-32.         [ Links ]

13. Edwards A, Bull AMJ, Amis AA. The attachment of the fibre bundles of the posterior cruciate ligament: An anatomical study. Arthroscopy 2007;23(3):284-90.         [ Links ]

14. Lopes OV, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH. Topography of the femoral attachment of the posterior cruciate ligament. Bone Joint Surgery (Am) 2008;90:249-55.         [ Links ]

15. Sheps DM, Otto D, Fernhout M. The anatomic characteristics of the tibial insertion of the posterior cruciate ligament. Arthroscopy 2005;21(7):820-5.         [ Links ]

16. Moorman CT, Zane MSM, Bansai S, Cina SJ, Wickiewicz TL, Warren RF, Kaseta MK. Tibial insertion of the posterior cruciate ligament: A sagittal plane analysis using gross, histological and radiographic methods. Arthroscopy 2008;24(2):269-75.         [ Links ]

17. De Frate LE, Gill TJ, Li G. In vivo function of the posterior cruciate ligament during weightbearing flexion. Am J Sports Med 2004;32(8):1923-8.         [ Links ]

18. Covey DC, Sapega AA, Sherman GM. Testing for isometry during reconstruction of the posterior cruciate ligament. Anatomic and biomechanical considerations. Am J Sports Med 1996;24(6):740-6.         [ Links ]

19. Ahmad CS, Cohen A, Levine WN, Gardner TR, Ateshian GA, Mow C. Codominance of the individual posterior cruciate ligament bundles. Am J Sports Med 2003;31(2):221-5.         [ Links ]

20. Heller L, Langman J. The meniscofemoral ligaments in the human knee. J Bone Joint Surg (Br) 1964;46:307-13.         [ Links ]

21. Gupte CM, Bull AMJ, Thomas R de W, Amis AA. A review of the function and biomechanics of the menisco-femoral ligaments. Arthroscopy 2003;19(2):161-71.         [ Links ]

22. Moran CJ, Poyton AR, Moran R, O'Brien M. Analysis of meniscofemoral ligament tension during knee motion. Arthroscopy 2006;22(4):362-6.         [ Links ]

23. Walters J, Solomons. M. Gluteus minimus: Observations on its insertion. Journal of Anatomy 2001 Feb;198:239-42.         [ Links ]

24. Amis AA, Gupte CM, Bull AMJ, Edwards A. Anatomy of the posterior cruciate ligaments and the menisco-femoral ligaments. Knee Surg Sports Traumatol Arthrosc 2006;14:257-63.         [ Links ]

25. Clancy WGJ, Shelbourne KD, Zoellner GB. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. J Bone Joint Surg (Am) 1983;65:310-22.         [ Links ]

26. Matara MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion as a function of the knee flexion angle: Implications for posterior cruciate ligament reconstruction. Arthroscopy 2000;16(8):796-804.         [ Links ]

27. Shetty AA, Tindale AJ, Querski F, Divekar M, Fernando KWK. The effect of knee flexion on the popliteal artery and its clinical significance. J Bone Joint Surg (Br) 2003;85:218-22.         [ Links ]

28. Zaidi SHA, Cobb AG, Bentley G. Danger to the popliteal artery in high tibial osteotomy. J Bone Joint Surg (Br) 1995;7:384-6.         [ Links ]

29. Ahn JH. Posterior trans-septal approach for arthroscopic surgery of the knee. Arthroscopy 2000;16:774-9.         [ Links ]

30. Kramer DE, Bank MS, Casio BM, Cosgarea AJ. Posterior knee arthroscopy: Anatomy, technique, application. J Bone Joint Surg (Am) 2006;88:110-21.         [ Links ]

31. Horner G, Dellor AL. Innervation of the human knee joint and implications for surgery. Clin Orthop 1994;301:221-6.         [ Links ]

32. Hirasawa Y, Okajima S, Ohta M, Tokioka T. Nerve distribution to the human knee joint anatomical and immunohistological study. International Orthopaedics (Sicot) 2004;24:1-4.         [ Links ]

33. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its importance: Am J Sports Med 1982;10(6):329-34.         [ Links ]

34. Giffen JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 2007;35(9):1443-9.         [ Links ]

 

 

Correspondence:
Dr JJ Marais
Durbanville Medi-Clinic
PO Box 3484
7551 Durbanville
Tel: (021) 975-2686; Fax: (021) 975-2688
Email: kmarais@kingsley.co.za

 

 

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