Magnetic Resonance imaging evaluation of the distance to the popliteal artery in arthroscopic popliteus tendon versus posterior cruciate ligament reconstruction

Purpose: Wide acceptance of arthroscopically treating posterolateral corner injuries has not occurred. There remains a fear of neurovascular (NV) injury while arthroscopically performing these reconstructions. The study's aim is to compare on Magnetic Resonance Scans the distance of the tibial tunnel in an arthroscopic popliteus tendon reconstruction (APB) and arthroscopic posterior cruciate ligament (PCL) reconstruction (APC) to the popliteal neurosvascular bundle. Methods: MRI scans of 93 patients were evaluated. The tibial tunnel exit point of an APB and an APC reconstruction was marked. The smallest distance of the center of the exit point of these tunnels to the NV bundle was assessed. Mean variances and distances were assessed. A Welch's unpaired t-test was calculated. The difference in variances was also assessed. Results: Mean distance to NV bundle from the tibial tunnel in an APB procedure was 15.9 mm. The mean distance to the NV bundle from an APC tibial tunnel was 11.2 mm. The Welch's unpaired t-test p-value was <0.0001. The p-value of the test for equality of variances was 0.0002. Conclusion: The distance to the NV bundle from the tibial tunnel of an APB is significantly higher than the distance to the NV bundle from the tibial tunnel of a APC. However, there is a significantly larger variance in distance to the NV bundle in an APB. Drilling a tibial tunnel during an APB should therefore not be considered more dangerous than drilling the tibial tunnel during an APC.