LUO Hao, AO Ying-fang, ZHANG Wei-guang, LIU Sheng-yong, ZHANG Ji-ying , YU Jia-kuo

Background  Several techniques have been described for posterior cruciate ligament (PCL) reconstruction. However, double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported. The current study investigated this technique, focusing on the anatomy of the femoral and tibial insertions of the anterolateral (AL) and posteromedial (PM) bundles of the PCL.
Methods  Twenty-two fresh, healthy adult cadaveric knees were dissected and measured. The PCL was divided into the AL bundle and PM bundle at the insertion footprint. The insertion footprints of the AL and PM bundles, their location, size, and the clock positions were measured and described.
Results  On the femur, the clock position of the footprint of the AL bundle was 11:21±0:23 (left) or 0:39±0:23 (right), and the PM bundle was 9:50±0:18 (left) or 2:10±0:18 (right), with the knee flexed at 90 degrees. The distances from the center of the femoral insertions of the AL and PM bundles to the anterior cartilage margins of the medial femoral condyle were (7.79±1.22) mm and (8.36±1.63) mm, respectively. On the tibia, the vertical distances from the center of the tibial insertions of the AL and PM bundles to the tibial articular surface were (3.25±1.20) mm and (6.91±1.57) mm, respectively.
Conclusions  These results have led to a better definition of the anatomy of the AL and PM bundle footprint of the PCL. The technique of double-bundle PCL reconstruction using quadruple bone-tunnel is feasible. Application of these data during PCL reconstruction using the quadruple bone-tunnel technique may help optimize knee stability.