Comparison of Tibial Tunnel Techniques in Posterior Cruciate Ligament Reconstruction: C-Arm Versus Anatomic Fovea Landmark

Abstract

Purpose: To evaluate the accuracy of the posterior cruciate ligament (PCL) fovea landmark against conventional fluoroscopic pin placement retrospectively using 3-dimensional computed tomography (3D CT).

Methods: This retrospective comparison focused on the tibial tunnel locations determined in consecutive 26 patients using the fluoroscopic imaging technique (group I) and in consecutive 23 patients using the PCL fovea landmark technique without the help of the fluoroscopy (group II) for tibial tunnel formation. The 3D surface-modeled CT images that appropriately located the position of the PCL fovea on the tibial plateau were used. Ratios between total length of the fovea and length of the tunnel center from the medial border (coronal) and posterior edge (sagittal) were evaluated.

Results: The ratios between sagittal tunnel length and total sagittal length for groups I and II were 35.4% ± 12.2% and 44.1% ± 23.1%, respectively (P = .07). The ratios between the coronal tunnel lengths and total coronal lengths for groups I and II were 47.3% ± 9.2% and 57.3% ± 18.1%, respectively: group II showed a more laterally positioned tibial tunnel than did group I (P = .03).

Conclusions: A more laterally located tibial tunnel was produced using the PCL fovea landmark technique. However, the differences in centers were small and probably not clinically relevant. Therefore, the PCL fovea landmark technique might be an alternative method to the fluoroscopic imaging technique for locating the anatomic tibial tunnel during transtibial PCL reconstruction.

Level of evidence: Level III, retrospective comparative study.