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Accurate placement of the femoral tunnel position is an important aspect of cruciate ligament reconstruction surgery. However, a wide range of positions have been described in the literature for the femoral tunnels for posterior cruciate ligament (PCL) reconstruction, and there is no consensus regarding the optimal placement. It was hypothesised that some of the prior studies used femoral PCL graft tunnels that were outside of the anatomical attachments. A systematic review and descriptive anatomical study in vitro were undertaken. Fifty articles that described PCL reconstruction since 1917 were reviewed; the description of the femoral tunnel placement was reproducible from only 20 of these. A right, distal femur was disarticulated and the PCL attachment was dissected; the centres of the anterolateral and posteromedial bundles were marked and confirmed to be close to the mean published data. The tunnel positions described in the 20 papers were also marked. The descriptions of 15 of the 20 anterolateral and 4 of the 5 posteromedial bundle tunnel centres were close (within +/-2 mm deep and +/-01:00 o'clock) to the anatomical centres of the bundle attachments. Other tunnels were placed either deeper or shallower than the anatomical attachments. The mean positions were: 7 mm from the articular cartilage at 1 o'clock for the anterolateral bundle, and 8 mm from the cartilage at 3 o'clock for the posteromedial bundle, in a right knee. It was concluded that it was not possible to replicate the tunnel positions used in most of the literature because of inadequate descriptions. Most of the usable descriptions of the anterolateral bundle position were close to the anatomical centre, but some tunnels were placed non-anatomically. A reproducible system for description of the femoral tunnel positions should be used. [ABSTRACT FROM AUTHOR]

Different methods to reconstruct damaged posterolateral structures are available, but there has been little work studying their relative performance in combined PCL plus posterolateral corner (PLC) deficiency. We hypothesized that an 'anatomic' reconstruction with three graft bundles crossing the joint line would restore knee laxity closer to normal than a modified two-bundle Larson reconstruction. In a controlled laboratory study, the kinematics of cadaveric knees were measured electromagnetically with posterior drawer, external rotation, or varus rotation loads applied, with the knee at sequential stages: intact, PCL-deficient; PCL plus PLC-deficient; modified Larson reconstruction; anatomic PLC reconstruction. The graft bundles were tensioned sequentially to restore specific degrees of freedom to intact values of laxity at specific angles of knee flexion. A significant difference was not found between the two reconstructions. Both reconstructions restored external rotation and varus laxity to normal. Both restored posterior drawer to that caused by isolated PCL deficiency, but did not restore posterior laxity to normal. It was concluded that, with appropriate graft tensioning, both PLC reconstructions could restore both external rotation and varus laxity to normal, but not posterior drawer. The three-stranded anatomical reconstruction did not perform better than the modified two-strand Larson technique. Both of these isolated PLC reconstructions in knees with combined PCL plus PLC deficiency restored the knees to the laxity condition of an isolated PCL-deficiency, they could not reduce posterior drawer to normal. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the anatomical locations of the femoral attachments of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL). Twenty-two human cadaver knees with intact ACLs were used. The femoral attachments of the two bundles were identified, marked and photographed. They were measured and described in terms of the o'clock positions parallel to the femoral long axis and parallel to the roof of the intercondylar notch. The centres of the bundles were also measured in a high-low and a superficial-deep manner referencing from the centre of the posterior femoral condyle, and with respect to their positions within a measurement grid defined in this study. The bulk of the AM bundle was attached between the 9.30 and 11.30 o'clock positions and the PL bundle between the 8.30 and 10 o'clock positions. The AM and PL bundles were consistently found in specific zones of the measurement grid. Using the posterior condyle reference method, the centre of the AM bundle was at 68 +/- 7% (range 57-78) in a shallow-deep direction and 55 +/- 5% (44-62) in a high-low direction. The PL bundle was found at 56 +/- 8% (40-73) in a shallow-deep direction, and 62 +/- 7.0% (40-70) in a high-low direction. The attachment was oriented at 37 degrees to the femoral long axis. The results from this study could be used to guide ACL reconstruction techniques. [ABSTRACT FROM AUTHOR]