Operative Techniques in Sports Medicine
Volume 17, Issue 3 , Pages 126-134 , July 2009

Anatomy and Biomechanics of the Posterior Cruciate Ligament and Other Ligaments of the Knee

  • Karl F. Bowman Jr, MD

      Affiliations

    • Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
    • ,
  • Jon K. Sekiya, MD

      Affiliations

    • MedSport–Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
    • Corresponding Author InformationAddress reprint requests to Jon K. Sekiya, MD, MedSport–Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Dr, PO Box 0391, Ann Arbor, MI 48106-0391

References 

  1. Ramos LA, de Carvalho RT, Cohen M, et al. Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy. 2008;24:1367–1372
  2. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint (Anatomical, functional and experimental analysis). Clin Orthop Relat Res. 1975;106:216–231
  3. Edwards A, Bull AM, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: An anatomic study. Arthroscopy. 2007;23:284–290
  4. Ahmad CS, Cohen ZA, Levine WN, et al. Codominance of the individual posterior cruciate ligament bundles (An analysis of bundle lengths and orientation). Am J Sports Med. 2003;31:221–225
  5. Harner CD, Xerogeanes JW, Livesay GA, et al. The human posterior cruciate ligament complex: An interdisciplinary study (Ligament morphology and biomechanical evaluation). Am J Sports Med. 1995;23:736–745
  6. Forsythe B, Harner C, Martins CA, et al. Topography of the femoral attachment of the posterior cruciate ligament (Surgical technique). J Bone Joint Surg Am. 2009;91(suppl 2, pt 1):89–100
  7. Mejia EA, Noyes FR, Grood ES. Posterior cruciate ligament femoral insertion site characteristics (Importance for reconstructive procedures). Am J Sports Med. 2002;30:643–651
  8. Tajima G, Nozaki M, Iriuchishima T, et al. Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am. 2009;91:859–866
  9. Mariani PP, Margheritini F, Bellelli A. Bone mineral density of the proximal metaphysis of tibia: Clinical relevance in posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13:263–267
  10. Gupte CM, Smith A, Jamieson N, et al. Meniscofemoral ligaments—Structural and material properties. J Biomech. 2002;35:1623–1629
  11. Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: Implications for posterior cruciate ligament reconstruction. Arthroscopy. 2000;16:796–804
  12. LaPrade RF, Engebretsen AH, Ly TV, et al. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89:2000–2010
  13. LaPrade RF, Morgan PM, Wentorf FA, et al. The anatomy of the posterior aspect of the knee (An anatomic study). J Bone Joint Surg Am. 2007;89:758–764
  14. LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: A qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med. 2003;31:854–860
  15. Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee (Effect of sectioning the posterior cruciate ligament and posterolateral structures). J Bone Joint Surg Am. 1988;70:88–97
  16. Kennedy JC, Hawkins RJ, Willis RB, et al. Tension studies of human knee ligaments (Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments). J Bone Joint Surg Am. 1976;58:350–355
  17. Marinozzi G, Pappalardo S, Steindler R. Human knee ligaments: Mechanical tests and ultrastructural observations. Ital J Orthop Traumatol. 1983;9:231–240
  18. Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res. 1976;263–270
  19. Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 1994;27:13–24
  20. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee (A biomechanical study). J Bone Joint Surg Am. 1980;62:259–270
  21. Race A, Amis AA. Loading of the two bundles of the posterior cruciate ligament: An analysis of bundle function in a-P drawer. J Biomech. 1996;29:873–879
  22. Hughston JC, Bowden JA, Andrews JR, et al. Acute tears of the posterior cruciate ligament (Results of operative treatment). J Bone Joint Surg Am. 1980;62:438–450
  23. Amis AA, Bull AM, Gupte CM, et al. Biomechanics of the PCL and related structures: Posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc. 2003;11:271–281
  24. Ritchie JR, Bergfeld JA, Kambic H, et al. Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee (Influence on posterior tibial translation). Am J Sports Med. 1998;26:389–394
  25. Sekiya JK, Whiddon DR, Zehms CT, et al. A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuries (Evaluation of isolated and combined deficiency). J Bone Joint Surg Am. 2008;90:1621–1627
  26. Castle TH, Noyes FR, Grood ES. Posterior tibial subluxation of the posterior cruciate-deficient knee. Clin Orthop Relat Res. 1992;284:193–202
  27. Harner CD, Hoher J, Vogrin TM, et al. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics (A human cadaveric study). Am J Sports Med. 1998;26:669–673
  28. Fontbote CA, Sell TC, Laudner KG, et al. Neuromuscular and biomechanical adaptations of patients with isolated deficiency of the posterior cruciate ligament. Am J Sports Med. 2005;33:982–989
  29. Iwata S, Suda Y, Nagura T, et al. Posterior instability near extension is related to clinical disability in isolated posterior cruciate ligament deficient patients. Knee Surg Sports Traumatol Arthrosc. 2007;15:343–349
  30. Logan M, Williams A, Lavelle J, et al. The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med. 2004;32:1915–1922
  31. Bergfeld JA, McAllister DR, Parker RD, et al. The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut. J Bone Joint Surg Am. 2001;83-A:1339–1343
  32. Sekiya JK, West RV, Ong BC, et al. Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy. 2005;21:1042–1050
  33. Pearsall AT, Pyevich M, Draganich LF, et al. In vitro study of knee stability after posterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1996;264–271
  34. Race A, Amis AA. PCL reconstruction (In vitro biomechanical comparison of “isometric” versus single and double-bundled “anatomic” grafts). J Bone Joint Surg Br. 1998;80:173–179
  35. Bergfeld JA, Graham SM, Parker RD, et al. A biomechanical comparison of posterior cruciate ligament reconstructions using single- and double-bundle tibial inlay techniques. Am J Sports Med. 2005;33:976–981
  36. Wang CJ, Chen HH, Chen HS, et al. Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: A cadaveric knee study. Arthroscopy. 2002;18:496–501
  37. Markolf KL, Slauterbeck JR, Armstrong KL, et al. A biomechanical study of replacement of the posterior cruciate ligament with a graft (Part II: Forces in the graft compared with forces in the intact ligament). J Bone Joint Surg Am. 1997;79:381–386
  38. Shearn JT, Grood ES, Noyes FR, et al. Two-bundle posterior cruciate ligament reconstruction: How bundle tension depends on femoral placement. J Bone Joint Surg Am. 2004;86-A:1262–1270
  39. Carson EW, Deng XH, Allen A, et al. Evaluation of in situ graft forces of a 2-bundle tibial inlay posterior cruciate ligament reconstruction at various flexion angles. Arthroscopy. 2007;23:488–495
  40. Whiddon DR, Zehms CT, Miller MD, et al. Double compared with single-bundle open inlay posterior cruciate ligament reconstruction in a cadaver model. J Bone Joint Surg Am. 2008;90:1820–1829
  41. Mauro CS, Sekiya JK, Stabile KJ, et al. Double-bundle PCL and posterolateral corner reconstruction components are codominant. Clin Orthop Relat Res. 2008;466:2247–2254
  42. Sekiya JK, Haemmerle MJ, Stabile KJ, et al. Biomechanical analysis of a combined double-bundle posterior cruciate ligament and posterolateral corner reconstruction. Am J Sports Med. 2005;33:360–369
  43. Wu CH, Chen AC, Yuan LJ, et al. Arthroscopic reconstruction of the posterior cruciate ligament by using a quadriceps tendon autograft: A minimum 5-year follow-up. Arthroscopy. 2007;23:420–427
  44. Chuang TY, Chen CH, Chou SW, et al. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction. Arthroscopy. 2004;20:331–335
  45. Bergfeld JA, Graham SM. Tibial inlay procedure for PCL reconstruction: One tunnel and two tunnel. Oper Tech Sports Med. 2001;9:69–75
  46. Markolf KL, Zemanovic JR, McAllister DR. Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods. J Bone Joint Surg Am. 2002;84A:518–524
  47. Bergfeld JA, McAllister DR, Parker RD, et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med. 2001;29:129–136
  48. Margheritini F, Mauro CS, Rihn JA, et al. 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. 2004;32:587–593
  49. McAllister DR, Markolf KL, Oakes DA, et al. A biomechanical comparison of tibial inlay and tibial tunnel posterior cruciate ligament reconstruction techniques: Graft pretension and knee laxity. Am J Sports Med. 2002;30:312–317
  50. Oakes DA, Markolf KL, McWilliams J, et al. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament (Analysis of graft forces). J Bone Joint Surg Am. 2002;84A:938–944
  51. Campbell RB, Jordan SS, Sekiya JK. Arthroscopic tibial inlay for posterior cruciate ligament reconstruction. Arthroscopy. 2007;23:1356.e1–1356.e4
  52. Campbell RB, Torrie A, Hecker A, et al. Comparison of tibial graft fixation between simulated arthroscopic and open inlay techniques for posterior cruciate ligament reconstruction. Am J Sports Med. 2007;35:1731–1738
  53. Zehms CT, Whiddon DR, Miller MD, et al. Comparison of a double bundle arthroscopic inlay and open inlay posterior cruciate ligament reconstruction using clinically relevant tools: A cadaveric study. Arthroscopy. 2008;24:472–480
  54. Fanelli GC, Edson CJ. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy. 2004;20:339–345
  55. Freeman RT, Duri ZA, Dowd GS. Combined chronic posterior cruciate and posterolateral corner ligamentous injuries: A comparison of posterior cruciate ligament reconstruction with and without reconstruction of the posterolateral corner. Knee. 2002;9:309–312
  56. Harner CD, Vogrin TM, Hoher J, et al. Biomechanical analysis of a posterior cruciate ligament reconstruction (Deficiency of the posterolateral structures as a cause of graft failure). Am J Sports Med. 2000;28:32–39
  57. Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am. 2001;83A:106–118
  58. Kim SJ, Choi CH, Kim HS. Arthroscopic posterior cruciate ligament tibial inlay reconstruction. Arthroscopy. 2004;20(suppl 2):149–154

PII: S1060-1872(09)00116-6

doi: 10.1053/j.otsm.2009.07.001

Operative Techniques in Sports Medicine
Volume 17, Issue 3 , Pages 126-134 , July 2009

Article Tools

* Image Usage & Resolution