Abstract
The PCL is considered an intra-articular and extra-synovial structure and its dimensions have been well described. Its length is 32–38 mm with a cross-sectional area of 11 mm2, and the bony insertion sites are three times larger than its mid-substance [11]. The average area of the femoral footprint of the anterolateral (AL) bundle is 118 ± 23.95 and of the posteromedial (PM) bundle is 90 ± 16.13 [23]. The distance from the medial articular cartilage has been found at 13 mm posteriorly and inferiorly [33]. The average area of the tibial footprint of the AL bundle is 93.1 ± 16.6 and of the PM bundle is 150.8 ± 31 [48]. The distance from the medial articular cartilage has been found at 8 mm posteriorly and 20 mm inferiorly. Both bundles insert as a unique tendon on the posterior aspect of the tibia approximately 1–1.5 cm distal to the joint line and their centre is located, medial to lateral, 48 % of the width of the tibial plateau [8].
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References
De Maeseneer M, Jager T, Vanderdood K, Van Roy P, Shahabpour M, Marcelis S (2003) Ultrasound during dissection of cadaveric specimens: a new method for obtaining ultrasound-anatomic correlations in musculoskeletal radiology. Eur Radiol 14:870–874
Godfrey JD (1973) Ligamentous injuries of the knee. Curr Pract Orthop Surg 5:56–92
Van Hoof T, Gomes GT, Audenaert E, Verstraete K, Kerckaert I, D’Herde K (2008) 3D computerized model for measuring strain and displacement of the brachial plexus following placement of reverse shoulder prosthesis. Anat Rec (Hoboken) 291:1173–1185
Baker CL Jr, Norwood LA, Hughston JC (1984) Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med 12:204–208
Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15:553–557
Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee: effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg 70A:88–97
Forsythe B, Harner C, Martins CA, Shen W, Lopes OV Jr, Fu FH (2009) Topography of the femoral attachment of the posterior cruciate ligament. Surgical technique. J Bone Joint Surg Am 91(Suppl 2 Pt 1):89–100
Groscurth P, Eggli P, Kapfhammer J, Rager G, Hornung JP, Fasel JDH (2001) Gross anatomy in the surgical curriculum in Switzerland: improved cadaver preservation, anatomical models, and course development. Anat Rec (New Anat) 265:254–256
Miller MD, Harner CD, Kashiwaguchi S (1994) Acute posterior cruciate ligament injuries. In: Fu FH, Harner CD, Vince KG (eds) Knee surgery, vol 1. Williams & Wilkins, Baltimore, pp 749–768
Noyes FR, Barber-Westin SD (1996) Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee. Am J Knee Surg 9:200–214
Fisher SP, Fox JM, Del Pizzo W et al (1991) Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone and Joint Surg 73A:2–10
Clancy WG Jr, Shelbourne KD, Zoellner GB et al (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg 65A:310–322
Covey DC, Sapega AA (1993) Injuries to the posterior cruciate ligament. J Bone Joint Surg 75A:1376–1386
Harner CD, Hoher J (1998) Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 26(3):471–82
Tajima G, Nozaki M, Iriuchishima T, Ingham SJ, Shen W, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91(4):859–66
Miller M, Bergfeld JA, Fowler PJ, Harner CD, Noyes FR (1999) The posterior cruciate ligament injured knee: principles of evaluation and treatment. AAOS Instr Course Lect 48:199–207
Parolie JM, Bergfeld JA (1986) Long-term results of non-operative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38
Shelbourne KD, Davis TJ, Patel DV (1999) The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries: a prospective study. Am J Sports Med 27:276–283
Lee YS, Han SH, Jo J, Kwak KS, Nha KW, Kim JH (2011) Comparison of 5 different methods for measuring stress radiographs to improve reproducibility during the evaluation of knee instability. Am J Sports Med 39:1275–1281
Kam CK, Chee DW, Peh WC (2010) Magnetic resonance imaging of cruciate ligament injuries of the knee. Can Assoc Radiol J 61:80–89
Schulz MS, Steenlage ES, Russe K, Strobel MJ (2007) Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 89:332–338
Sidles JA, Clark JM, Garbini JL (1991) A geometric theory of the equilibrium mechanics of fibers in ligaments and tendons. J Biomech 24:943–949
McAllister DR, Miller MD, Sekiya JK, Wojtys EM (2009) Posterior cruciate ligament biomechanics and options for surgical treatment. Instr Course Lect 58:377–388
Logan M, Williams A, Lavelle J et al (2004) The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med 32:1915–1922
Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB (2007) Advanced MR imaging of the cruciate ligaments. Radiol Clin North Am 45:1003–16
Cosgarea AJ, Jay PR (2001) Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg 9:297–307
Noyes F, Barber-Weston S, Grood E (2001) Newer concepts in the treatment of posterior cruciate ligament ruptures. In: Insall JN, Scott WN (eds) Surgery of the knee, 3rd edn. Churchill Livingstone, New York, NY, pp 841–878
Muller W (1983) The knee: form, function and ligament reconstruction. Springer, Berlin, pp 246–248
Sekiya JK, Whiddon DR, Zehms CT, Miller MD (2008) A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries: evaluation of isolated and combined deficiency. J Bone Joint Surg Am 90:1621–1627
Lutz GE, Palmitier RA, An KN et al (1993) Comparison of tibio-femoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg Am 75:732–739
Grover JS, Basset LW, Gross ML et al (1990) Posterior cruciate ligament: MR imaging. Radiology 174:527–530
Kannus P, Bergfeld J, Jarvinen M et al (1991) Injuries to the posterior cruciate ligament of the knee. Sports Med 12:110–131
Staubli HU, Jakob RP (1990) Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament. J Bone Joint Surg Br 72:225–230
Noyes FR, Stowers SF, Grood ES et al (1993) Posterior subluxations of the medial and lateral tibiofemoral compartments. An in vitro ligament sectioning study in cadaveric knees. Am J Sports Med 21:407–414
Irizarry JM, Recht MP (1997) MR imaging of the knee ligaments and the postoperative knee. Radiol Clin North Am 35:45–76
Lopez-Vidriero E, Simon DA, Johnson DH (2010) Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications. Sports Med Arthrosc 18:230–237
Allen CR, Kaplan LD, Fluhme DJ, Harner CD (2002) Posterior cruciate ligament injuries. Curr Opin Rheumatol 14:142–149
Senter C, Hame SL (2006) Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury. Sports Med 36:635–641
Fanelli GC, Beck JD, Edson CJ (2011) Combined PCL-ACL lateral and medial side injuries: treatment and results. Sports Med Arthrosc 19:120–130
Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of the knee. Clin Sports Med 13:615–627
Van de Velde SK, Bingham JT et al (2009) Analysis of tibiofemoral cartilage deformation in the posterior cruciate ligament-deficient knee. J Bone Joint Surg Am 91:167–175
Skyhar MJ, Warren RF, Ortiz GJ et al (1993) The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg Am 75:694–699
Turner DA, Prodromos CC, Petasnick JP et al (1985) Acute injuries of the ligaments of the knee: magnetic resonance evaluation. Radiology 154:717–722
Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15:553–557
Jung TM, Reinhardt C, Scheffler SU, Weiler A (2006) Stress radiography to measure posterior cruciate ligament insufficiency: a comparison of five different techniques. Knee Surg Sports Traumatol Arthrosc 14:1116–1121
Noyes FR, Barber-Westin SD (1996) Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee. Am J Knee Surg 9:200–214
Heron CW, Calvert PT (1992) Three-dimensional gradient-echo MR imaging of the knee. Comparison with arthroscopy in 100 patients. Radiology 183:839–844
Hewett TE, Noyes FR, Lee MD (1997) Diagnosis of complete and partial posterior cruciate ligament ruptures: stress radiography compared with KT-1000 arthrometer and posterior drawer testing. Am J Sports Med 25(5):648–55
Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ (2002) Fixed posterior subluxation in posterior cruciate ligament-deficient knees: diagnosis and treatment of a new clinical sign. Am J Sports Med 30:32–38
Kozanek M, Fu EC, Van de Velde SK et al (2009) Posterolateral structures of the knee in posterior cruciate ligament deficiency. Am J Sports Med 37:534–541
Matava MJ, Ellis E, Gruber B (2009) Surgical treatment of posterior cruciate ligament tears: an evolving technique. J Am Acad Orthop Surg 17:435–446
Schulz MS, Steenlage ES, Russe K, Strobel MJ (2007) Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 89:332–338
Margheritini F, Frascari Diotallevi F, Mariani PP (2011) Posterior cruciate ligament reconstruction using an arthroscopic femoral inlay technique. Knee Surg Sports Traumatol Arthrosc 19:2033–5
Mariani PP, Margheritini F (2006) Full arthroscopic inlay reconstruction of posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:1038–44
Polly DW Jr, Callaghan JJ, Sikes RA et al (1988) The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee. J Bone Joint Surg 70A:192–198
Louisia S, Siebold R, Canty J, Bartlett RJ (2005) Assessment of posterior stability in total knee replacement by stress radiographs: prospective comparison of two different types of mobile bearing implants. Knee Surg Sports Traumatol Arthrosc 13:476–482
Menetrey J, Garavaglia G, Fritschy D (2007) Definition, classification, rationale and treatment for PCl deficient knee. Rev Chir Orthop Reparatrice Appar Mot 93:5S70–73
Schulz MS, Russe K, Lampakis G, Strobel MJ (2005) Reliability of stress radiography for evaluation of posterior knee laxity. Am J Sports Med 33:502–506
Voos JE, Mauro CS, Wente T et al (2011) Posterior cruciate ligament. Anatomy, biomechanics, and outcomes. Am J Sports Med. doi:10.1177/0363546511416316, Epub July 29, ahead of print
Torg JS, Barton TM, Pavlov H et al (1989) Natural history of the posterior cruciate ligament-deficient knee. Clin Orthop 246:208–216
Ahn JH, Yoo JC, Wang JH (2005) Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft–clinical results of a minimum 2-year follow-up. Arthroscopy 21:965–969
Bergfeld JA, McAllister DR, Parker RD et al (2001) A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med 29:129–136
Hiraga Y, Ishibashi Y, Tsuda E, Toh HT (2006) Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests. Knee Surg Sports Traumatol Arthrosc 14:13–19
Lim HC, Bae JH, Wang JH et al (2009) The biomechanical performance of bone block and soft-tissue posterior cruciate ligament graft fixation with interference screw and cross-pin techniques. Arthroscopy 25:250–256
Mckernan DJ, Weiss JA, Deffner KT (1995) Tensile properties of gracilis, semitendinosus and patellar tendons from the same donor. Trans Orthop Res Soc 20:39
Markolf K, Davies M, Zoric B, McAllister D (2003) Effects of bone block position and orientation within the tibial tunnel for posterior cruciate ligament graft reconstructions: a cyclic loading study of bone-patellar tendon-bone allografts. Am J Sports Med 31:673–679
Noyes FR, Barber SD (1993) Allograft reconstruction of the anterior and posterior cruciate ligaments: report of ten-year experience and results. Instr Course Lect 42:381–396
Markolf KL, Feeley BT, Tejwani SG et al (2006) Changes in knee laxity and ligament force after sectioning the posteromedial bundle of the posterior cruciate ligament. Arthroscopy 22:1100–1106
Race A, Amis AA (1998) PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 80:173–179
Harner CD, Janaushek MA, Kanamori A et al (2000) Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151
Whiddon DR, Zehms CT, Miller MD et al (2008) Double compared with single-bundle open inlay posterior cruciate ligament reconstruction in a cadaver model. J Bone Joint Surg Am 90:1820–1829
Bergfeld JA, Graham SM, Parker RD et al (2005) A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques. Am J Sports Med 33:976–981
Weimann A, Wolfert A, Zantop T et al (2007) Reducing the “killer turn” in posterior fixation level and smoothing the tibial aperture. Arthroscopy 23:1104–1111
Margheritini F, Rihn JA, Mauro CS et al (2005) Biomechanics of initial tibial fixation of posterior cruciate ligament reconstruction. Arthroscopy 21:1164–1171
Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11:69–76
Ruberte Thiele RA, Campbell RB et al (2010) Biomechanical comparison of figure-of-8 versus cylindrical tibial inlay constructs for arthroscopic posterior cruciate ligament reconstruction. Arthroscopy 26:977–983
Markolf KL, Zemanovic JR, McAllister DR (2002) Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. J Bone Joint Surg Am 84:518–524
Kim SJ, Kim TE, Jo SB, Kung YP (2009) Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques. J Bone Joint Surg Am 91:2543–2549
Zehms CT, Whiddon DR, Miller MD et al (2008) Comparison of a double bundle arthroscopic inlay and open inlay posterior cruciate ligament reconstruction using clinically relevant tools: a cadaveric study. Arthroscopy 24:472–480
LaPrade RF, Johansen S, Wentorf FA et al (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414
Larson RV (2001) Isometry of the lateral collateral and popliteofibular ligaments and techniques for reconstruction using a free semitendinosus tendon graft. Oper Tech Sports Med 9:84–90
Noyes FR, Barber-Westin SD (2007) Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med 35:259–273
Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 22:159–165
Shelbourne KD, Carr DR (2003) Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment. Instr Course Lect 52:413–418
Yoshiya S, Kuroda R, Mizuno K (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33:1380–1385
Fanelli GC, Harris JD (2006) Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc 14:78–83
Ahmad CS, Cohen ZA, Levine WN et al (2003) Co-dominance of the individual posterior cruciate ligament bundles: an analysis of bundle lengths and orientation. Am J Sports Med 31:221–225
Chhabra A, Kline AJ, Harner CD (2006) Single-bundle versus double-bundle posterior cruciate ligament reconstruction: scientific rationale and surgical technique. Instr Course Lect 55:497–507
Edwards A, Bull AM, Amis AA (2007) The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23:284–290
Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231
Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69:233–242
Harner CD, Xerogeanes JW, Livesay GA et al (1995) The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med 23:736–745
Lopes OV Jr, Ferretti M, Shen W et al (2008) Topography of the femoral attachment of the posterior cruciate ligament. J Bone Joint Surg Am 90:249–255
Moran CJ, Poynton AR, Moran R, Brien MO (2006) Analysis of meniscofemoral ligament tension during knee motion. Arthroscopy 22:362–366
Morgan CD, Kalman VR, Grawl DM (1997) The anatomic origin of the posterior cruciate ligament: where is it?–reference landmarks for PCL reconstruction. Arthroscopy 13:325–331
Nagasaki S, Ohkoshi Y, Yamamoto K et al (2006) The incidence and cross-sectional area of the meniscofemoral ligament. Am J Sports Med 34:1345–1350
Tajima G, Nozaki M, Iriuchishima T et al (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866
Veltri DM, Warren RF (1993) Isolated and combined posterior cruciate ligament injuries. J Am Acad Orthop Surg 1:67–75
Clancy WG Jr, Shelbourne KD, Zoellner GB et al (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament: report of a new procedure. J Bone Joint Surg Am 65:310–322
Harner CD, Janaushek MA, Kanamori A et al (2000) Biomechanical analysis of a doublebundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151
Hermans S, Corten K, Bellemans J (2009) Long-term results of isolated anterolateral bundle reconstructions of the posterior cruciate ligament: a 6- to 12-year follow-up study. Am J Sports Med 37:1499–507
Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11:69–76
Thomann YR, Gaechter A (1994) Dorsal approach for reconstruction of the posterior cruciate ligament. Arch Orthop Trauma Surg 113:142–8
Margheritini F, Mauro CS, Rihn JA et al (2004) Biomechanical comparison of tibial inlay versus transtibial techniques for posterior cruciate ligament reconstruction: analysis of knee kinematics and graft in situ forces. Am J Sports Med 32:587–593
MacGillivray JD, Stein BE, Park M et al (2006) Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year followup. Arthroscopy 22:320–328
Ahn JH, Nha KW, Kim YC et al (2006) Arthroscopic femoral tensioning and posterior cruciate ligament reconstruction in chronic posterior cruciate ligament injury. Arthroscopy 22:341.e1–4
Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL (2006) Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy 22:329–38
Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35:1443–9
Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–597
Wascher DC, Grauer JD, Markoff KL (1993) Biceps tendon tenodesis for posterolateral instability of the knee: an in vitro study. Am J Sports Med 21:400–406
Harner CD, Vogrin TM, Hoher J et al (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction: deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39
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Van Hoof, T. et al. (2012). Anatomy – Biomechanics – Novel Imaging of the Native PCL. In: Menetrey, J., Zaffagnini, S., Fritschy, D., van Dijk, N. (eds) ESSKA Instructional Course Lecture Book. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29446-4_6
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