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Measurement of Posterior Tibial Translation in the Posterior Cruciate Ligament-Reconstructed Knee

Significance of the Shift in the Reference Position

From the Musculoskeletal Research Center, Department of Orthopaedic Surgery University of Pittsburgh, Pittsburgh, Pennsylvania

^* Address correspondence and reprint requests to Christopher D. Harner, MD, Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, PO Box 71199, Pittsburgh, PA 15213

Background: The measurement of anterior or posterior tibial translation depends on the existence of a repeatable and accurate reference position of the knee from which the corresponding translation is measured.

Hypothesis: Clinical measurements of posterior tibial translation alone do not accurately reflect the laxity of posterior cruciate ligament-reconstructed knees.

Study Design: Controlled laboratory study.

Methods: Ten human cadaveric knees were tested by using a robotic/universal force-moment sensor testing system. The reference positions and the resulting kinematics in response to a 134-N anterior-posterior tibial load were determined for the intact and reconstructed knees. Posterior cruciate ligament reconstruction was performed with the graft tensioned and fixed at two different positions: 1) 90° of knee flexion with a 134-N anterior tibial load and 2) full extension with no load.

Results: Posterior cruciate ligament reconstruction with graft fixation at full extension with no load resulted in anterior shift of the reference position by 1.5 to 3.2 mm. The reconstruction resulted in an overconstrained knee with significantly decreased total anterior-posterior translation of 2.6 to 3.2 mm. However, the posterior tibial translation measured was not significantly different from that of the intact knee. Posterior cruciate ligament reconstruction with graft fixation performed at 90° of flexion with a 134-N anterior tibial load resulted in kinematics similar to those of the intact knee.

Conclusion: Posterior tibial translations that are measured clinically can be misleading because the reference position of the knee can be shifted significantly after posterior cruciate ligament reconstruction.

Clinical Relevance: The measurement of total anterior-posterior translation may be a more accurate way to assess kinematics of the reconstructed knee.