Anatomical relationship between the proximal tibia and posterior neurovascular structures: a safe zone for surgeries involving the proximal tibia.

The purpose of this study was to provide a quantitative description of the anatomical relationship between the proximal tibia and posterior neurovascular structures to delineate a safe zone for tibial surgery. We measured the distance between the tibial cortex and neurovascular structures, and the width of the medial/lateral part of the tibia without neurovascular structures, using magnetic resonance imaging data of 50 knees. The average distance was <10 mm. Neurovascular structures passed just lateral to the posterior middle line of the tibia, with major branches passing laterally at 5.5 to 6 cm below the joint line. There was a safe zone posterior to the medial half of the tibia for penetration of the posterior cortex.