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PCL Anatomy

 pcl picture

Posterior Cruciate Ligament

  • Function: PCL is responsible for 95% of total restraint to posterior translation of the tibia. Secondary restraint to tibial external rotation.
  • Length: 38mm; Intra-articular length = 30.7 +/- 2.6mm (Miller MD, Am J Knee Surg 1995;8:68). Width: 13mm. (Harner CD, AJSM 1995;23:736).

PCL Arthroscopic image (ACL removed)

  1. PCL
  2. Medial femoral condlye
  3. Lateral femoral condyle

 

PCL Origin and Insertion

 

PCL Origin and Insertion

  • Origin: Broad crescent-shaped area on the anterolateral aspect of the medial femoral condyle. (Girgis FG, CORR 1975:216-231).
  • Insertion: Posterior tibia, 1-1.5cm below the articular surface. (Girgis FG, CORR 1975:216-231). AL surface area = 93.1mm2, PM=150.8mm2 (Tajimo G, JBJS 2009;91A:859)
  • Consists of an anterolateral portion and a postermedial portion, and the meniscofemoral ligaments (ligaments of Humphrey and Wrisberg).
  • Anterolateral portion is tight in flexion. Anterolateral portion is 2x larger/stronger than posteromedial portion. (Harner CD, AJSM 1995;23:736)
  • Postermedial portion is tight in extension.

A- Oblique view of femoral notch.
B-Posterior view of proximal tibia.

PCL Blood Supply

PCL Blood Supply

Posterior view of the knee demonstrating blood supply.

  1. Popliteal artery
  2. Superior lateral genicular artery
  3. Superior medial genicular artery
  4. Middle geniculate artery
  5. Inferior lateral genicular artery
  6. Inferior medial genicular artery
 

PCL Innervation

  • Posterior articular nerve (a branch of the tibial nerve) (Kennedy JC, JBJS 1974;56A:223). Normal PCL has proprioceptive senses that help protect the knee joint during use which are lost after reconstruction.
PCL MRI - Normal

PCL MRI - Normal

  • 96-100% accurate in determining all posterior cruciate ligament (PCL) injuries. (Fischer  JBJS 73A:2-10 1991).
  • PCL appears as thick dark band extending from the medial femoral condyle to the posterior tibia best seen on oblique sagittal images.
  • PCL disruption = discontinuity, abnormal course, or fluid signal traversing the ligament on T2 images.
PCL MRI - Rupture

PCL MRI - Rupture

  • Sagittal FSE T2 MRI of 28y/o male with PCL and ACL tears.
  • Image through the intercondylar notch demonstrating torn PCL shown.
  1. Stump of PCL demonstrating discontinuity with origin on medial femoral condyle and lax, abnormal contour.
pcl reconstruction image

PCL s/p Reconstruction

  • Arthroscopic image of intercondylar notch s/ ACL / PCL reconstruction.
  • ACL was reconstruction with a semitendinosis and gracilis autograft with endobutton femoral fixation and Mitek Bio-Intrafix tibial fixation.
  • PCL was reconstruction using an inlay technique with bone-patellar tendon-bone allograft using two 4.5mm cannulated screws for tibial fixation and a metal interference screw for femoral fixation.
  1. Medial femoral condyle
  2. PCL bone-patellar tendon-bone graft
  3. ACL hamstring graft
  4. Lateral femoral condyle

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