Increasing the distance between the posterior cruciate ligament and the popliteal neurovascular bundle by a limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction - A cadaveric angiographic study

Background: During arthroscopic transtibial posterior cruciate ligament reconstruction, popliteal vessel injury is the most serious complication, and it rarely occurs. Purpose: To evaluate the distance change between the posterior cruciate ligament and the neurovascular bundle by limited release of the posterior capsule during arthroscopic posterior cruciate ligament reconstruction. Study Design: Controlled laboratory study. Methods: The authors performed an arthroscopic posterior cruciate ligament reconstruction procedure on 10 fresh-frozen cadaveric knees. The experimental procedure included 4 steps. Before the procedure and just after each step, angiographic lateral radiographs were checked to find the relationship and the distances between the popliteal artery and the posterior cruciate ligament. Changes in the distances at each step were compared and analyzed by ANOVA with Bonferroni correction. Results: The mean distance between the popliteal artery and the tibial insertion of the posterior cruciate ligament increased significantly (from 4.4 +/- 3.2 mm to 14.7 +/- 4.1 mm) after limited posterior capsular release (P < .01). The distance from the popliteal artery to the midsubstance of the posterior cruciate ligament at the level of the posterior trans-septal portal significantly increased (from 11.3 +/- 3.9 mm to 17.6 +/- 4.0 mm) just after distension of the knee joint with a pump (P < .01). Conclusion: This study showed a significant increase in the distance from the popliteal artery to the posterior cruciate ligament through arthroscopic limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction. Clinical Relevance: The results of this study support the claim that risk of iatrogenic popliteal vessel injury could be reduced by limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction.