The medial meniscal root as a landmark for tibial tunnel position in posterior cruciate ligament reconstruction

As a result of improved basic science knowledge and operative techniques, posterior cruciate ligament (PCL) reconstructions have steadily increased over the past 10 years. Even for the experienced arthroscopist, PCL reconstruction surgery can be technically challenging and fraught with complications. The most technically demanding aspect of the procedure may be placement and drilling of the tibial tunnel. Reasons for this include unfamiliarity with the posterior aspect of the knee, neurovascular risk, and the relative infrequency of the procedure being performed by most surgeons. We propose that the root of the posterior horn of the medial meniscus is an easily identifiable visible landmark that can not only aid in the localization of the position of the tibial tunnel in PCL reconstruction but also assist navigation in the posterior aspect of the knee arthroscopically.