Tibial Tunnel Preparation in Posterior Cruciate Ligament (PCL) Reconstruction. A Technical Tip to Lessen the Stress

The purpose of this study was to introduce a technical tip for the preparation of tibial tunnel in a posteriorcruciate ligament (PCL) reconstruction to reduce the chance of popliteal artery injury and duration of the surgery.

This study included 18 patients who underwent PCL reconstructions at Imam Khomeini University Hospital,Tehran, Iran, between 2016 and 2017. In all patients, the PCL tibial aimer device was inserted from the anteromedialportal and its tip aimed 8-9 mm below shiny white fibers in PCL facet. Subsequently, the smooth guide pin was insertedfrom anteromedial tibial cortex and advanced just to the posterior cortex but not through it based on the measurementof tibial tunnel length. Thereafter, the reaming was done over the guide pin. As the pin was engaged in the posteriorcortex, it was assured that it would not run before the reamer to the popliteal fossa. The pin was removed when thereamer touched the posterior cortex, and the reaming continued until reamer’s head appeared in the PCL facet. Othersteps of standard arthroscopic PCL reconstruction were done in this study. All patients were subjected to computedtomography scans.

The mean age of the patients and the mean duration of surgery were 25±3 years and 95 min, respectively.There was no vascular injury, and the position of the tibial tunnel in all cases was accurate. Moreover, the meandistance between the centers of the tibial tunnel to champagne-glass drop-off of the posterior cortex of tibia wasobtained at 7.42 mm (range: 4.6-10.4 mm).

This study showed that avoiding the penetration of posterior cortex of the tibia by means of the pin duringtibial tunnel preparation for PCL reconstruction is a safe, reproducible, and time-saving technique. This techniqueeliminates the need for fluoroscopy during the procedure.Level of evidence: IV