nullTibial Tunnel
in PCL ReconstructionTibial Tunnel
in PCL ReconstructionSung-Jae Kim et al, ISAKOS Newsletter (Current Concepts), 2004
Sung-Jae Kim et al, Arthroscopy, 2004
Sung-Jae Kim et al, CORR, 1999
Sung-Jae Kim et al, Arthroscopy, 1998
Sung-Jae Kim et al, Arthroscopy, 1994nullSung-Jae Kim M.D.,Jong-Min Kim M.D.
Jun-Dae Kwun M.D.,Kwang-Am Jung M.D.,
Andri MT Lubis M.D.
Department of Orthopaedic Surgery,
Yonsei University College of Medicine, Seoul,Korea
IntroductionIntroductionConsiderations in Tibial Tunnel
Placement of tibial tunnel
Direction of tibial tunnelHistorical Review (I)Historical Review (I)Placement of Tibial Tunnel
Grood et al, Am J Sports Med, 1989
Bach et al, Am J Sports Med, 1992
: Variations in tibial tunnel position have less effect
on graft behavior than that of the femoral tunnel
Sung-Jae Kim et al, Arthroscopy, 1994
1. Reproduce the anterolateral component of PCL
in graft tunnel placement
2. Post. flat spot of the tibia 1 cm below
articular margin & just lateral to the midline Historical Review (I)Historical Review (I)Placement of Tibial Tunnel
Miller et al, Knee Surgery, 1994
Harner et al, Am J Sports Med, 1998
: Reproduce the anterolateral component of PCL
in graft tunnel placementHistorical Review (I)Historical Review (I)Placement of Tibial Tunnel
Mariani et al. Arthroscopy, 1999
: Proper location of femoral tunnel is more
critical & difficult than tibial tunnel
Kantaras et al,Arthroscopy, 2002
: medial meniscal root attachment used as
anatomical landmark for tibial tunnel
Historical Review (II)Historical Review (II)Placement of Tibial Tunnel
Markolf et al, J Orthop Res, 2003
: errors in medial-lateral placement of
the tibial tunnel
→ not important effects on biomechanics
Historical Review (II)Historical Review (II)Direction of Tibial Tunnel
Sung-Jae Kim et al, Arthroscopy, 1994
: Anteromedial tibial tunnel
Sung-Jae Kim et al, Arthroscopy, 1998
: Anterolateral tibial tunnel reduces stress
concentration & graft failure
Ohkoshi et al, Arthroscopy, 2001
: By selecting lateral route, it becomes possible
to reduce the killer turnHistorical Review (II)Historical Review (II)Direction of Tibial Tunnel
Sung-Jae Kim et al, ISAKOS Newsletter
(Current Concepts), 2004
: On biomechanical study, lateral approach is highly
promising compared to the other approaches nullArthroscopic Intraarticular Interference
Screw Technique of PCL Reconstruction
: one-incision technique. IAA, Copenhagen, 1993
JOA, Yokohama, 1995
ESKA, Budapest, 1996
AAOS, San Francisco, 1997
AAOS, New Orleans, 1998
Sung-Jae Kim et al, Arthroscopy, 1994
Sung-Jae Kim et al, CORR, 1999
PCL recon. : one-incision techniquePCL recon. : one-incision techniqueDirection of tibial tunnel
: from anteromedial
Post. flat spot of the tibia
1 cm below articular margin
& just lateral to the midline
Reproduce the anterolateral
component of PCL
in graft tunnel placement
PCL recon. : one-incision techniquePCL recon. : one-incision techniqueAnteromedial tibial tunnelPCL recon. : one-incision techniquePCL recon. : one-incision techniquenull
A modified endoscopic technique for
PCL reconstruction using allograft
Sung-Jae Kim et al, Arthroscopy, 1998Modified endoscopic technique
for PCL Recon.Modified endoscopic technique
for PCL Recon.Tibial tunnel was made through,
1. Anterolat. tibial cortex 2cm lat. to the tibial tuberosity
2. Post. flat spot of the tibia
1 cm below articular margin
3. Just lateral to the midline(S-J Kim, Arthroscopy,1998)Modified endoscopic technique
for PCL Recon.Modified endoscopic technique
for PCL Recon.
• Less stress concentration
& graft failure
• Inspect tibial tunnel
• Short tunnel length
• Less additional fixation
problem(S-J Kim, Arthroscopy,1998)
Advantage of lateral tunnelModified endoscopic technique
for PCL Recon.Modified endoscopic technique
for PCL Recon.Modified endoscopic technique
for PCL Recon.Modified endoscopic technique
for PCL Recon.Less divergence of the graft
within the tibial tunnel & knee jointMore vertical direction
& less acute angle of the graftAnteromedial tunnelAnterolateral tunnelnull
PCL tunnel : Biomechanical Comparisons of Three Different Tibia Tunnel Directions in PCL Reconstruction
Sung-Jae Kim et al, ISAKOS Newsletter (Curren Concepts),2004
Sung-Jae Kim et al, Arthroscopy, 2005PurposePurposeOne reason of the present dilemma
in treating PCL injured patients is the
abrasions around Killer Turn
To compare three types of transtibial
tunnel directions:
• medial, central, lateral approach Material & MethodsMaterial & MethodsSix cadavers
Pressure-sensitive thin film in replacement
PCL graft & killer-turn area of the tibia
Trilinear elastic & viscoelastic properties
1.Von Mises stresses : criterion for failure
2.Maximum shear stress
3.Resultant forceMaterial & MethodsMaterial & MethodsResultsResultsThe digitized image
from the pressure sensitive filmsThe ratios of the No. of black pixels
to the total No. of pixelsMaterial & MethodsMaterial & Methods
medial15mm20mmcentralResultsResults Trilinear elastic solutionResultsResultsViscoelastic properties : von Mises stressResultsResultsViscoelastic properties : Max. shear stressResultsResultsViscoelastic properties : Resultant forceConclusionConclusion
This qualitative study suggests that
the lateral approach technique
seems to be more promising than
the other techniques. nullThank You
for Your Attention