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Purpose: To elucidate the effects of various tibial and femoral attachment locations on the theoretical length changes and isometry of PCL grafts in healthy knees during in vivo weightbearing motion., Methods: The intact knees of 14 patients were imaged using a combined magnetic resonance and dual fluoroscopic imaging technique while the patient performed a quasi-static lunge (0°-120° of flexion). The theoretical end-to-end distances of the 3-dimensional wrapping paths between 165 femoral attachments, including the anatomic anterolateral bundle (ALB), central attachment and posteromedial bundle (PMB) of the PCL, connected to an anterolateral, central, and posteromedial tibial attachment were simulated and measured. A descriptive heatmap was created to demonstrate the length changes on the medial condyle and formal comparisons were made between the length changes of the anatomic PCL and most isometric grafts., Results: The most isometric graft, with approximately 3% length change between 0° and 120° of flexion, was located proximal to the anatomic femoral PCL attachments. Grafts with femoral attachments proximal to the isometric zone decreased in length with increasing flexion angles, whereas grafts with more distal attachments increased in length with increasing flexion angles. The ALB and central single-bundle graft demonstrated a significant elongation from 0° to 120° of flexion (p < 0.001). The PMB decreased in length between 0° and 60° of flexion after which the bundle increased in length to its maximum length at 120° (p < 0.001). No significant differences in length changes were found between either the ALB or PMB and the central graft, and between the ALB and PMB at flexion angles ≥ 60° (n.s.)., Conclusions: The most isometric attachment was proximal to the anatomic PCL footprint and resulted in non-physiological length changes. Moving the femoral attachment locations of the PCL significantly affected length change patterns, whereas moving the tibia locations did not. The importance of anatomically positioned (i.e., distal to the isometric area) femoral PCL reconstruction locations to replicate physiological length changes is highlighted. These data can be used to optimize tunnel positioning in either single- or double-bundle and primary or revision PCL reconstruction cases., Level of Evidence: IV.

Purpose: To elucidate the effects of various tibial and femoral attachment locations on the theoretical length changes and isometry of PCL grafts in healthy knees during in vivo weightbearing motion.Methods: The intact knees of 14 patients were imaged using a combined magnetic resonance and dual fluoroscopic imaging technique while the patient performed a quasi-static lunge (0°-120° of flexion). The theoretical end-to-end distances of the 3-dimensional wrapping paths between 165 femoral attachments, including the anatomic anterolateral bundle (ALB), central attachment and posteromedial bundle (PMB) of the PCL, connected to an anterolateral, central, and posteromedial tibial attachment were simulated and measured. A descriptive heatmap was created to demonstrate the length changes on the medial condyle and formal comparisons were made between the length changes of the anatomic PCL and most isometric grafts.Results: The most isometric graft, with approximately 3% length change between 0° and 120° of flexion, was located proximal to the anatomic femoral PCL attachments. Grafts with femoral attachments proximal to the isometric zone decreased in length with increasing flexion angles, whereas grafts with more distal attachments increased in length with increasing flexion angles. The ALB and central single-bundle graft demonstrated a significant elongation from 0° to 120° of flexion (p < 0.001). The PMB decreased in length between 0° and 60° of flexion after which the bundle increased in length to its maximum length at 120° (p < 0.001). No significant differences in length changes were found between either the ALB or PMB and the central graft, and between the ALB and PMB at flexion angles ≥ 60° (n.s.).Conclusions: The most isometric attachment was proximal to the anatomic PCL footprint and resulted in non-physiological length changes. Moving the femoral attachment locations of the PCL significantly affected length change patterns, whereas moving the tibia locations did not. The importance of anatomically positioned (i.e., distal to the isometric area) femoral PCL reconstruction locations to replicate physiological length changes is highlighted. These data can be used to optimize tunnel positioning in either single- or double-bundle and primary or revision PCL reconstruction cases.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Hip pain in patients with normal bony anatomy and anterior labral injury may be related to compression of the iliopsoas tendon across the anterior capsulolabral complex. No attempts to characterize the 3-dimensional anatomy of the iliopsoas tendon and its relationship to the acetabular labrum have been reported to date. Hypothesis: The iliopsoas tendon directly overlies the capsulolabral complex. Contribution of the muscle belly and tendon to the overall circumference at the level of the labrum is approximately the same. Study Design: Descriptive laboratory study. Materials and Methods: Eight hip joints were dissected and cross-sectional measurements of the iliopsoas muscle-tendon complex were performed using digital calipers and image analysis software. Results: The iliopsoas tendon in all specimens was located directly anterior to the anterosuperior capsulolabral complex at the 2 to 3 o'clock position. The overall length of the iliopsoas tendon from the lesser trochanter to the acetabular labrum was 75.4 ± 0.9 mm. The circumference of the iliopsoas tendon at the lesser trochanter was 25.5 ± 2.6 mm, the iliopsoas tendon at the level of the labrum was 28.4 ± 2.8 mm, and the iliopsoas tendon-muscle belly complex at the level of the labrum was 63.8 ± 7.4 mm. At the level of the labrum, the iliopsoas is composed of 44.5% tendon and 55.5% muscle belly. Conclusion: The close anatomic relationship of the iliopsoas tendon to the anterior capsulolabral complex suggests that iliopsoas pathologic changes at this level may lead to labral injury. Additionally, these data suggest that at the level of the labrum, 45% of the tendon-muscle belly complex should be released to release the entire tendinous portion. Clinical Relevance: Knowledge of the cross-sectional anatomy of the iliopsoas tendon and its relationship to the acetabular labrum will better assist surgeons in treating lesions associated with iliopsoas injury. [ABSTRACT FROM AUTHOR]