Posteromedial Versus Direct Posterior Approach for Posterior Cruciate Ligament Reinsertion

Avulsion fractures of the posterior cruciate ligament (PCL) are usually found in pediatric populations. This study investigated which of 2 approaches-posteromedial or direct posterior-enables easier PCL reinsertion. Ten fresh cadavers were studied using direct posterior (10 knees) and posteromedial (10 knees) approaches. In both, a guidewire was inserted into the tibial insertion of the PCL as perpendicular as possible to the coronal knee axis. Then, the angle between the guidewire and the horizontal plane of the table was measured. The mean angle of the guidewire was 8.6 degrees (SD=7.3 degrees) with the direct posterior approach and 36.6 degrees (SD=14.3 degrees) with the posteromedial approach (P=.005). The direct posterior approach allows a greater degree of freedom compared with the posteromedial approach to reach the PCL tibial insertion.