Quantitative analysis on effect of different tibial tunnel positions on killer turn of posterior cruciate ligament

doi:10.3877/cma.j.issn.1674-134X.2022.06.012

Abstract

Abstract:

Objective

To quantitatively analyze the effects of different tibial tunnel positions on the coronal and three-dimentional(3D) "killer turn" angles based on computer simulation of the posterior cruciate ligament (PCL) reconstruction.

Methods

A 3D model of the knee joint was established using the CT data. The PCL attachment points on the femur and tibia were located. Using the transtibial technique, the tibial tunnels at the anteromedial, tibial-tubercle and anterolateral positions were simulated using a sagittal angle of 50°. All the outcomes were measured using the Rhinoceros 6.0, and data analysis was performed by chi square analysis; coronal killer turn and 3D killer turn angles of the patients with different height and age were analyzed by subgroup analysis.

Results

Different tibial tunnel positions had significant effects on the PCL coronal and 3D angles of killer turn. The coronal angles of killer turn were: (128±9)°, 146±6)°, and (170±7)° for the anteromedial, tibial-tuberosity and anterolateral tibial tunnels, respectively. The 3D angles of the killer turn were: (97±7)°, (104±7)°, and (112±8)° for the anteromedial, tibial-tuberosity and anterolateral tibial tunnels, respectively. There were statistically significant differences regarding coronal and 3D angles of the killer turn among groups (coronal angles: F=3 896.102, 3D angles: F=1 301.216, both P<0.001). Subgroup analysis showed that height and age had no statistically significant difference in the coronal and 3D angles of the killer turn. Correlation linear analysis was performed on the coronal and the 3D killer turn, and the result showed the regression equation as follows: ?=52.67+ 0.35×x(x: the coronal angle of the killer turn, ?: the 3D angle of the killer turn).

Conclusion

Different tibial tunnel positions shows significant effects on the PCL coronal and 3D angles of killer turn, and the anterolateral tibial tunnel could significantly increase the 3D angle of killer turn and theoretically reduce the graft abrasion.

Key words: Posterior cruciate ligament, Tibia, Imaging, three-dimensional

Yuanjun Teng, Nian Tan, Gengxin Jia, Zheng Zhang, Changxi Li, Laiwei Guo, Lianggong Zhao, Yayi Xia. Quantitative analysis on effect of different tibial tunnel positions on killer turn of posterior cruciate ligament[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 729-734.

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Figures/Tables 8

References 22

[1]	Bedi A, Musahl V, Cowan JB. Management of posterior cruciate ligament injuries：an evidence-based review[J]. J Am Acad Orthop Surg, 2016, 24(5): 277－289.
[2]	蔡伟创，徐一宏，徐卫东．后交叉韧带的解剖及病理生理与生物力学研究[J/CD]．中华关节外科杂志(电子版)，2021，15(4)：470－475.
[3]	Saragaglia D, Francony F, Gaillot J, et al. Posterior cruciate ligament Reconstruction for chronic lesions: clinical experience with hamstring versus ligament advanced reinforcement system as graft[J]. Int Orthop, 2020, 44(1): 179－185.
[4]	Li Y, Zhang J, Song G, et al. The mechanism of "killer turn" causing residual laxity after transtibial posterior cruciate ligament reconstruction[J]. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2016, (3)：13－18.
[5]	Teng Y, Jia G, Da L, et al. The permissive safe angle of the ribial runnel in transtibial posterior cruciate ligament reconstruction: a three-dimensional simulation study[J]. Orthop Surg, 2022, 14(6)：1193－1202.
[6]	Berg EE. Posterior cruciate ligament tibial inlay reconstruction[J]. Arthroscopy, 1995, 11(1): 69－76.
[7]	Markolf KL, Zemanovic JR, Mcallister DR. Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods[J]. J Bone Joint Surg Am, 2002, 84(4): 518－524.
[8]	Bergfeld JA, Mcallister DR, Parker RD, et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques[J]. Am J Sports Med, 2001, 29(2): 129－136.
[9]	Ohkoshi Y, Nagasaki S, Yamamoto K, et al. Description of a new endoscopic posterior cruciate ligament Reconstruction and comparison with a 2-incision technique[J]. Arthroscopy, 2003, 19(8): 825－832.
[10]	Kim SJ, Shin JW, Lee CH, et al. Biomechanical comparisons of three different tibial tunnel directions in posterior cruciate ligament reconstruction[J]. Arthroscopy, 2005, 21(3): 286－293.
[11]	Akagi M, Oh M, Nonaka T, et al. An anteroposterior axis of the tibia for total knee arthroplast[J]. Clin Orthop Relat Res, 2004, (420): 213－219.
[12]	Teng Y, Mizu-Uchi H, Xia Y, et al. Axial but not sagittal hinge axis affects posterior tibial slope in medial open-wedge high tibial osteotomy: a 3-dimensional surgical simulation study[J]. Arthroscopy, 2021, 37(7): 2191－2201.
[13]	Matziolis G, Krocker D, Weiss U, et al. A prospective，randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation[J]. J Bone Joint Surg Am, 2007, 89(2): 236－243.
[14]	Moon SW, Park SH, Lee BH, et al. The effect of hinge position on posterior tibial slope in medial open-wedge high tibial osteotomy[J]. Arthroscopy, 2015, 31(6): 1128－1133.
[15]	Johannsen AM, Anderson CJ, Wijdicks CA, et al. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions[J]. Am J Sports Med, 2013, 41(1): 35－42.
[16]	Teng YJ, Zhang XH, Ma CW, et al. Evaluation of the permissible maximum angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography[J]. Arch Orthop Trauma Surg, 2019, 139(4): 547－552.
[17]	Lynch TB, Chahla J, Nuelle CW. Anatomy and biomechanics of the posterior cruciate ligament[J]. J Knee Surg, 2021, 34(5): 499－508.
[18]	陈百成，闫昌葆．后交叉韧带重建中"成角效应"的研究现状[J/CD]．中华关节外科杂志(电子版)，2009，3(2)：242－245.
[19]	Teng Y, Guo L, Wu M, et al. MRI analysis of tibial PCL attachment in a large population of adult patients: reference data for anatomic PCL reconstruction[J]. BMC Musculoskelet Disord, 2016, 17(1): 384.
[20]	Teng Y, Da L, Jia G, et al. What Is the maximum tibial tunnel angle for transtibial PCL reconstruction? A comparison based on virtual radiographs, CT Images, and 3D knee models[J]. Clin Orthop Relat Res, 2022, 480(5): 918－928.
[21]	Huang TW, Wang CJ, Weng LH, et al. Reducing the "killer turn" in posterior cruciate ligament reconstruction[J]. Arthroscopy, 2003, 19(7): 712－716.
[22]	Ahn JH, Bae JH, Lee YS, et al. An anatomical and biomechanical comparison of anteromedial and anterolateral approaches for tibial tunnel of posterior cruciate ligament reconstruction：evaluation of the widening effect of the anterolateral approach[J]. Am J Sports Med, 2009, 37(9): 1777－1783.

参数	样本数	冠状杀伤角	3D杀伤角
前内侧隧道	89	128±9	97±7
胫骨结节隧道	89	146±6^a	104±7^a
前外侧隧道	89	170±7^ab	112±8^ab
F值		3 896.102	1 301.216
P值		<0.001	<0.001

参数	样本数	冠状杀伤角	3D杀伤角
前内侧隧道	89	128±9	97±7
胫骨结节隧道	89	146±6^a	104±7^a
前外侧隧道	89	170±7^ab	112±8^ab
F值		3 896.102	1 301.216
P值		<0.001	<0.001

分组	样本数	前内侧隧道冠状杀伤角	前内侧隧道3D杀伤角	胫骨结节隧道冠状杀伤角	胫骨结节隧道3D杀伤角	前外侧隧道冠状杀伤角	前外侧隧道3D杀伤角
18~30岁组	23	128±8	98±8	147±5	105±8	171±6.38	113±8
31~40岁组	41	127±8	96±8	147±6	103±8	170±8	111±8
41岁以上组	25	128±10	97±7	145±7	103±6	170±8	112±7
F值		0.040	0.294	0.987	0.387	0.616	0.494
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

分组	样本数	前内侧隧道冠状杀伤角	前内侧隧道3D杀伤角	胫骨结节隧道冠状杀伤角	胫骨结节隧道3D杀伤角	前外侧隧道冠状杀伤角	前外侧隧道3D杀伤角
18~30岁组	23	128±8	98±8	147±5	105±8	171±6.38	113±8
31~40岁组	41	127±8	96±8	147±6	103±8	170±8	111±8
41岁以上组	25	128±10	97±7	145±7	103±6	170±8	112±7
F值		0.040	0.294	0.987	0.387	0.616	0.494
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

分组	例数	前内侧隧道冠状杀伤角	前内侧隧道3D杀伤角	胫骨结节隧道冠状杀伤角	胫骨结节隧道3D杀伤角	前外侧隧道冠状杀伤角	前外侧隧道3D杀伤角
身高≤1.60 m组	36	128±7	98±6	146±5	105±7	170±7	113±7
1.61~1.70 m组	35	128±10	96±7	147±6	103±7	170±7	111±7
身高≥1.71 m组	18	127±9	95±9.12	146±7	101±9	169±8	109±9
F值		0.040	1.546	0.144	1.718	0.152	1.939
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

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