Anatomic ACL reconstruction: the normal central tibial footprint position and a standardised technique for measuring tibial tunnel location on 3D CT

Parkinson, Benjamin; Gogna, Rajiv; Robb, Curtis; Thompson, P.; Spalding, Tim

doi:10.1007/s00167-015-3683-8

Cited by 45 publications

(52 citation statements)

References 59 publications

(124 reference statements)

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“…[22][23][24][25] However, a significant variation in sagittal depth of the tibial tunnel placement between surgeons and institutions 25 has been reported using the quadrant technique. [26][27][28][29] Our measurement method makes up for evaluation between LM anterior root and tibial tunnel placement. Because the center of the ACL insertion was the bony insertion of the LM anterior root, 6 this variation could increase the risk for damage to the LM anterior insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Although a more posterior positioning of the tibial tunnel in the ACL footprint has traditionally been recommended for ACL reconstruction to lower the risk for roof impingement, 31,32 current recommendations are for localization of the aperture at the true center of the footprint of the tibial attachment of the ACL, adjacent to the anterior horn of the LM, with the goal of approximating the mechanical response of the reconstructed graft to the native ACL. 18,28,33,34 Ziegler et al and Zantop et al reported this "true" center to be located 7.5 mm from the center of the LM anterior root. 2,18 However, LaPrade et al 7 suggested that the functional importance of the supplemental soft tissue fibers of the LM anterior root should be considered and suggested a location at 5.0 mm from the center of the LM anterior root.…”

Section: Location Of the Tibial Tunnelmentioning

confidence: 95%

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Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

et al. 2017

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The anterior root of the lateral meniscus provides functional stability to the meniscus. In this study, we evaluated the relationship between the position of the tibial tunnel and extrusion of the lateral meniscus after anterior cruciate ligament reconstruction, where extrusion provides a proxy measure of injury to the anterior root. The relationship between extrusion and tibial tunnel location was retrospectively evaluated from computed tomography and magnetic resonance images of 26 reconstructed knees, contributed by 25 patients aged 17-31 years. A measurement grid was used to localize the position of the tibial tunnel based on anatomical landmarks identified from the three-dimensional reconstruction of axial computed tomography images of the tibial plateaus. The reference point-to-tibial tunnel distance (mm) was defined as the distance from the midpoint of the lateral edge of the grid to the posterolateral aspect of the tunnel aperture. The optimal cutoff of this distance to minimize post-operative extrusion was identified using receiver operating curve analysis. Extrusion of the lateral meniscus was positively correlated to the reference point-to-tibial tunnel distance (r = 0.64; p< 0.001), with a cutoff distance of 5 mm having a sensitivity to extrusion of 83% and specificity of 93%. The mean extrusion for a distance >5 mm was 0.40 ± 0.43 mm, compared to 1.40 ± 0.51 mm for a distance ≤5 mm (p < 0.001). Therefore, a posterolateral location of the tibial tunnel aperture within the footprint of the anterior cruciate ligament decreases the reference point-to-tibial tunnel distance and increases extrusion of the lateral meniscus post-reconstruction. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1625-1633, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Location Of the Tibial Tunnelmentioning

confidence: 95%

Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

et al. 2017

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“…Tunnel position both on the femoral and tibial side were evaluated according to the grid method of Parkinson et al 17 on a CT and MRI coronal and axial view, respectively. We have also confirmed the radiographic data with the direct arthroscopic view of the tunnel intraoperatively.…”

Section: Methodsmentioning

confidence: 99%

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

et al. 2019

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Anterior cruciate ligament (ACL) reconstruction represents one of the most successful orthopedic surgical procedures. Nevertheless, ACL revisions are still very frequent, with a small but relevant number of failures. The purpose of this study is to analyze the failure causes and the clinical outcomes of patients who underwent a re-revision ACL reconstruction. Between January 2009 and December 2017, 263 ACL revisions were performed by a single senior surgeon. Seventeen patients (12 males and 5 females) underwent re-revision ACL reconstruction meeting the inclusion criteria. The mean age was 28.4 years (range, 19–41 years). Before the re-revision, the patients were evaluated preoperatively and after a mean follow-up of 29 months (range, 13–58 months). Assessment included subjective and objective evaluations (Lysholm and International Knee Documentation Committee [IKDC]), KT-2000 arthrometer, radiographic study, and preoperative computed tomography scan. Five patients showed a too anterior previous femoral tunnel and seven a too vertical and posterior tibial tunnel; eight meniscal tears were found. Five patients had grade III–IV according to Outerbridge cartilage lesions. IKDC showed a statistically significant improvement (A + B 35%, C + D 65% preop, A + B 82%, C + D 18% postop, odds ratio: 0.1169; p = 0.0083). The mean Lysholm score ranged from 43 ± 9 to 87 ± 7 (p < 0.001). The KT-2000 arthrometer showed a statistically significant improvement from a mean of 5.8 ± 1.4 to 1.5 ± 1.1 (p < 0.001) at last follow-up. Out of 17 patients, only 4 returned to sports activity at the same preinjury levels. Postoperatively at the last follow-up after last revision surgery, no osteoarthritis evolution was observed. This study showed good clinical and radiological results after the last revision ACL surgery in patients with multiple failures of ACL reconstruction but only one-fourth of the patients returned to the same preoperative sport level. Traumatic events, technical errors, and untreated peripheral lesions are the main causes of multiple previous failures; the worst clinical outcomes were found in the patients with high grade of chondral lesions.

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“…Knowledge about the anatomy of a normal ACL is a key factor to the success of reconstructive surgery. In order to determine the physiological position of the tibial attachment of ACL, Parkinson et al [31] analyzed 76 magnetic resonance imaging (MRI) images and 26 3D computed tomography (CT) images of uninjured knees. Insertion of the ACL in the frontal plane was located at 48% ± 2% from the medial edge of the tibial plateau.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of tunnels (66% of all) were located from 30.0-39.9% of the AP diameter; 18% of tunnels were between 40% and 44.9%; 10% over 45.0%, and 6% in the range of 25.0 -29.9% [25]. The average values of the tibial ACL insertion in sagittal plane were 38-39% of the AP diameter [31,33], and more than 70% of the values were in the range from 30 and 50%. The sagittal tibial index values in our study differed from the above mentioned studies, because the tibial insertion of graft in our study was set more anteriorly (29.7% of the AB diameter).…”

Section: Discussionmentioning

confidence: 99%

Radiographic analysis of the tibial tunnel position after anterior cruciate ligament reconstruction

Ristić¹,

Ristić

Harhaji

et al. 2018

Med pregl

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Introduction. The aim of the study was to analyze the tibial tunnel position after anterior cruciate ligament reconstruction. Material and Methods. The study included 830 patients who underwent this operative procedure. There were four times more male than female patients. The tibial tunnel placement was analyzed on frontal and lateral radiograph images of the knee joint. Results. The average frontal tibial index was 55% (35 -68%), the average frontal tibial angle was 75 degrees (58 -90), the sagittal tibial index was 30% (15 -52%) and the sagittal tibial angle was 68 degrees (50 -89). Conclusion. A significant deviation from these values may potentially lead to failure of the anterior cruciate ligament reconstruction. SažetakUvod. Studija ima za cilj da analizira položaj tunela na golenjači nakon rekonstrukcije prednjeg ukrštenog ligamenta. Materijal i metode. Istraživanje je obuhvatilo 830 pacijenata kojima je izvršena rekonstrukcija ligamenta. U uzorku smo više od četiri puta imali zastupljene muškarce. Položaj tunela na golenjači analiziran je frontalnim i bočnim radiografskim snimcima kolena. Rezultati. Prosečna vrednost frontalnog tibijalnog indeksa iznosi 55% (35-68%), frontalnog tibijalnog ugla 75 stepeni (58-90), sagitalnog tibijalnog indeksa 30% (15-52%) i sagitalnog tibijalnog ugla 68 stepeni (50-89). Zaključak. Značajnija odstupanja od navedenih vrednosti potencijalno mogu dovesti do neuspeha rekonstrukcija prednjeg ukrštenog ligamenta. Ključne

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Anatomic ACL reconstruction: the normal central tibial footprint position and a standardised technique for measuring tibial tunnel location on 3D CT

Abstract: III.

Cited by 45 publications

References 59 publications

Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

Radiographic analysis of the tibial tunnel position after anterior cruciate ligament reconstruction

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