A Simple Evaluation of Anterior Cruciate Ligament Femoral Tunnel Position

Abstract

Femoral tunnel angle and inclination angle can be reliably determined from both posterior-to-anterior radiographs and sagittal MRI and provide a useful metric for characterizing femoral tunnel position.

Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

“…Tunnel position was determined as the measured angle between a line through the centre of the long axis of the femur and a line through the centre of the femoral tunnel. In concordance with the study by Illingworth et al [7], a tunnel angle below 32.7° was highly predictive of a nonanatomic tunnel. For this study, obviously the most relevant are the FAM and RAM drilling techniques (from Steiner and Smart [17], with permission) FTA measurement was performed by two independent, blinded observers (Fig.…”

Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

“…However, the reported coronal obliquity of the femoral tunnel was much lower using the traditional technique than our modified transtibial technique. 4,7,14,24 Importantly, the orifices of the femoral tunnels formed at a similar anatomic position, with slight differences in tunnel direction. The greater size of the femoral tunnel orifice resulting from the modified transtibial technique may have resulted from the more perpendicular direction of the guide wire to the lateral femoral condylar surface when using the AM portal technique.…”

Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis

“…This technique was motivated by the desire to establish whether osseous landmarks are a reliable navigational tool for tunnel placement during ACL reconstruction surgery. Anatomically, correct positing of the graft is important to restoring rotational stability of the knee for the patient [24]. Various surgical methods for tunnel placement exist, with identification of osseous landmarks on the ACL footprint being a popular choice among some experts [15].…”

“…The evolution of anatomic ACL reconstruction has focused on changing the femoral tunnel position from the traditional high '11 o'clock' notch position [32] to the more anatomic mid-bundle position within the ACL footprint [19]. The suggestion has been that the lower position on the lateral wall of the notch reduces the graft inclination angle to one which more closely resembles the native ACL and hence should have a greater chance of reproducing the normal kinematics of the knee, thereby restoring rotational stability [24].…”