A Consistent Landmark for Tibial Tunnel Placement in Arthroscopic Remnant-Preserving Posterior Cruciate Ligament Reconstruction: Use of Champagne-Glass Drop-Off and Lateral Cartilage Point—A Retrospective Case Series

Background/Objectives: Accurate tibial tunnel placement is critical for successful posterior cruciate ligament reconstruction (PCLR), yet remains technically demanding due to limited visualization and anatomic variability. This study aimed to demonstrate the feasibility of an arthroscopic technique for remnant-preserving PCLR using the champagne-glass drop-off and lateral cartilage point as consistently identifiable arthroscopic anatomic bony landmarks, and to evaluate the success rate of tibial tunnel placement in targeted position using postoperative magnetic resonance imaging (MRI). Methods: A retrospective review was performed of patients who underwent arthroscopic remnant-preserving PCLR using a trans-septal approach with the described dual-landmark technique between March 2020 and October 2022. Of 31 eligible patients, 20 with complete clinical follow-up and postoperative 1-year MRI were included for analysis. Tibial tunnel position was assessed on MRI to determine success rate of placement in the targeted inferior–lateral tibial footprint based on anatomic reference. Clinical outcomes, including knee range of motion and posterior laxity, were also evaluated. Results: MRI evaluation demonstrated tibial tunnel consistent placement with the predefined targeted zone in all patients (20/20). At a median follow-up of 745 days, the mean knee range of motion was 140.0 ± 12.7 degrees. Posterior stability assessment showed grade 0 laxity in 75% of patients and grade 1 laxity in 25%. No graft failures, neurovascular complications, infections, or revision PCLR procedures were observed. Conclusions: This retrospective case series suggests that the dual-landmark technique (champagne-glass drop-off and lateral cartilage point) may facilitate consistent tibial tunnel placement in remnant-preserving PCLR. Level of Evidence: IV (Retrospective case series).