A Simple Method to Minimize Vascular Lesion of the Popliteal Artery by Guidewire During Transtibial Posterior Cruciate Ligament Reconstruction: A Cadaveric Study

Abstract

To compare the outside-in transtibial lateral and medial approaches for posterior cruciate ligament (PCL) reconstruction regarding the guidewires and popliteal artery integrity. Twenty-two human cadaveric knees were used. A PCL tibial aimer was arthroscopically placed within the PCL footprint through the anteromedial portal for the medial approach and through the anterolateral portal for the lateral approach. For the medial approach, the drill guide was introduced through the anteromedial tibial cortex and the guidewire was advanced with the reamer beyond the posterior tibial cortex. For the lateral approach, the drill guide was introduced through the anterolateral tibial cortex and the guidewire was advanced with the reamer beyond the posterior tibial cortex. After this, the knee was dissected. The depth distance (DD) was defined as the distance between the popliteal artery and the tibial posterior cortex projected at the tibial level at which the guidewire intersected or passed by the artery. The guidewire travel distance was calculated as the distance the guidewire had to advance beyond the tibial cortex to intersect the popliteal artery or pass by it. With the medial approach, the popliteal artery was intersected in all knees with a mean DD of 12.20 mm and a mean guidewire travel distance of 15.90 mm. With the lateral approach, the popliteal artery was not intersected in any knee; its mean medial distance from the artery was 4.8 mm at a DD of 10.05 mm. There was a significant difference in the popliteal artery intersection incidence and DD between both groups (P < .0001 and P = .0003, respectively). The transtibial lateral approach for PCL reconstruction was a safer method than the medial approach regarding popliteal artery injury by a guidewire. This study presents a slight modification of the most frequently used PCL reconstruction technique, intending to minimize guidewire injury to the popliteal artery.