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. 2025 Nov 14;12(4):e70563.
doi: 10.1002/jeo2.70563. eCollection 2025 Oct.

Direct insertion of the posterior cruciate ligament tibial attachment and its relationship with the medial meniscus: A histological study

Akihiro Yamashita  1   2 , Kosuke Tabuchi  1   2 , Ryuki Hashida  1 , Keishiro Kikuchi  1 , Shotaro Kinouchi  1   2 , Seiichi Inoue  1 , Takashi Soejima  3 , Akira Maeda  3   4 , Shuji Horibe  5 , Koichi Watanabe  6 , Takahiro Okawa  1   2 , Koji Hiraoka  1
Affiliations

Direct insertion of the posterior cruciate ligament tibial attachment and its relationship with the medial meniscus: A histological study

Akihiro Yamashita et al. J Exp Orthop. .

Abstract

Purpose: In this study, we aimed to identify the direct insertion of the tibial attachment of the posterior cruciate ligament (PCL) using histological examination and evaluate its anatomical relationship with the medial meniscus (MM).

Methods: Twenty-one formalin-fixed cadaveric knees were examined. The PCL tibial attachment was analysed in sagittal (slices 1, 2 and 3) and coronal (slices 4, 5, 6 and 7) sections. Hematoxylin and eosin and Masson's trichrome staining were used for tissue evaluation. The tibial insertion length and direct insertion length were measured using ImageJ software. The relationship between direct insertion and anatomical parameters was analysed using Spearman's correlation coefficient.

Results: The mean medial anteroposterior length was 52.1 ± 3.7 mm. The mean tibial insertion lengths of the PCL were 9.8 ± 1.7 mm (slice 1), 10.8 ± 1.1 mm (slice 2) and 8.5 ± 0.9 mm (slice 3). The mean direct insertion lengths were 8.5 ± 1.4 mm (slice 1), 9.7 ± 1.0 mm (slice 2) and 7.5 ± 0.9 mm (slice 3). Direct insertion in slice 2 was significantly correlated with medial anteroposterior length (p < 0.05). In the sagittal plane, the MM posterior root was adjacent to the anterior edge of the PCL tibial insertion, with a clear bony change-point at the border. In the coronal plane, the medial tibial plateau and PCL were separated by the MM tibial attachment (slices 5 and 6).

Conclusions: The tibial attachment area of the PCL was shorter than that reported in previous gross anatomical studies. These findings provide important anatomical insights for PCL reconstruction and are essential for preventing iatrogenic MM injuries during tibial tunnel creation.

Level of evidence: N/A.

Keywords: PCL reconstruction; histology; medial meniscus; posterior cruciate ligament; tibia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Sagittal and coronal sections of the PCL for histological evaluation. (a) Sagittal plane perpendicular to the champagne glass drop‐off. (b) Coronal plane parallel to the champagne‐glass drop‐off. ACL, anterior cruciate ligament; LM, lateral meniscus; MM, medial meniscus; PCL, posterior cruciate ligament.
Figure 2
Figure 2
Histological findings at the posterior cruciate ligament tibial attachment site using hematoxylin and eosin staining. (a) Overall view. (b) ×100. (i) Ligament, (ii) noncalcified fibrocartilage layer, (iii) calcified fibrocartilage layer, (iv) bone.
Figure 3
Figure 3
Anatomical relationship between the posterior cruciate ligament tibial attachment and the medial meniscus in the sagittal plane. The arrow indicates the point of the bony change. (a) Posterior cruciate ligament. (b) Posterior root of the medial meniscus. (ⅰ) Direct insertion. (ⅱ) Tibial insertion.
Figure 4
Figure 4
Anatomical relationship between the posterior cruciate ligament tibial attachment and the medial meniscus in the coronal plane. (a) Posterior cruciate ligament. (b) Posterior root of the medial meniscus. (c) Medial tibial plateaus. (d) Lateral tibial plateaus. (e) Lateral meniscus.
See this image and copyright information in PMC

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