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Codominance of the Individual Posterior Cruciate Ligament Bundles

An Analysis of Bundle Lengths and Orientation

From the Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery and Orthopaedic Research Laboratory, Columbia University, New York, New York

^* Address correspondence and reprint requests to Christopher S. Ahmad, MD, Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, 622 West 168th Street, PH 11th Floor, New York, NY 10032

Background: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability.

Hypothesis: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension.

Study Design: Controlled laboratory study.

Methods: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized.

Results: Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°.

Conclusions: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension.

Clinical Relevance: Double-bundle reconstructions achieve more physiologic knee function.

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