Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures

Abstract

Background: Previous descriptions of the insertion site of the posterior cruciate ligament are inadequate. Hypothesis: More than one reference system is required to adequately represent the anatomy of the femoral attachment. Study Design: Descriptive anatomic study. Methods: Twelve cadaveric specimens were evaluated by using two measurement methods relative to the femoral articular cartilage margin and two methods relative to the intercondylar femoral roof. Results: Reference lines perpendicular to the articular cartilage best defined the 12- and 1-o'clock positions, and those perpendicular to the articular cartilage or parallel to the femoral shaft best defined the 2-, 3-, and 4-o'clock positions. The angle of the proximal attachment to the roof was 88° ± 5.5°. The posterior cruciate ligament was a continuum of fibers rather than two distinct bundles, and its attachment showed variability in shape and thickness, extending past the midline in the notch (11:21 ± 15 minutes to 4:12 ± 20 minutes, right knee). Conclusions: More than one measurement system is required to accurately describe the femoral origin of the posterior cruciate ligament. Clinical Relevance: Accurate assessment of the anatomy is crucial for successful surgical reconstruction of the posterior cruciate ligament femoral attachment.