Direct insertion of the posterior cruciate ligament tibial attachment and its relationship with the medial meniscus: A histological study.

Purpose: In this study, we aimed to identify the direct insertion of the tibial attachment of the posterior cruciate ligament (PCL) using histological examination and evaluate its anatomical relationship with the medial meniscus (MM). Methods: Twenty-one formalin-fixed cadaveric knees were examined. The PCL tibial attachment was analysed in sagittal (slices 1, 2 and 3) and coronal (slices 4, 5, 6 and 7) sections. Hematoxylin and eosin and Masson's trichrome staining were used for tissue evaluation. The tibial insertion length and direct insertion length were measured using ImageJ software. The relationship between direct insertion and anatomical parameters was analysed using Spearman's correlation coefficient. Results: The mean medial anteroposterior length was 52.1 ± 3.7 mm. The mean tibial insertion lengths of the PCL were 9.8 ± 1.7 mm (slice 1), 10.8 ± 1.1 mm (slice 2) and 8.5 ± 0.9 mm (slice 3). The mean direct insertion lengths were 8.5 ± 1.4 mm (slice 1), 9.7 ± 1.0 mm (slice 2) and 7.5 ± 0.9 mm (slice 3). Direct insertion in slice 2 was significantly correlated with medial anteroposterior length ( Conclusions: The tibial attachment area of the PCL was shorter than that reported in previous gross anatomical studies. These findings provide important anatomical insights for PCL reconstruction and are essential for preventing iatrogenic MM injuries during tibial tunnel creation. Level of Evidence: N/A.