Anatomic Anterior Cruciate Ligament Reconstruction: The Use of the Anterior Horn of the Lateral Meniscus as a Guide to Tibial Tunnel Placement

Abstract

Anatomic anterior cruciate ligament reconstruction has been shown to reduce the risk of graft failure and to improve patient-related clinical outcomes. The posterior border of the anterior horn of the lateral meniscus is a useful marker for anatomic tibial tunnel placement. Assessment of a preoperative magnetic resonance imaging scan can allow surgical planning of tibial tunnel placement to allow for anatomic, patient-specific tibial tunnel placement during anatomic anterior cruciate ligament reconstruction. We present this technique to show how to use the posterior border of the anterior horn of the lateral meniscus clinically.

The “Not” Good, the Bad and the Ugly: Prevention and Management of Common Intraoperative and Delayed Complications in Orthopedic Sports Medicine Surgical Procedures

“…9 Both the posterior aspect of the anterior horn of the lateral meniscus and the intermeniscal ligament anteriorly have been used as soft tissue references for TT placement. 10 It is the authors' preference to use these bony and soft tissue landmarks for reference, as well as the patient's native ACL footprint, as subtle anatomic differences arise from patient to patient. We will also heir on the anterior side of pin placement as the reamer has a tendency to kick posteriorly during tunnel drilling.…”

“…The authors described a bony prominence in front of the medial and lateral intercondylar tubercles and medial side of the medial intercondylar ridge (anterior ridge) which is a clear bony eminence anterior to the footprint connecting the anterior edge of the medial intercondylar eminence with a small groove on the lateral side (lateral groove), and a small pit between the medial and lateral intercondylar tubercles posteriorly (intertubercle fossa) 9. Both the posterior aspect of the anterior horn of the lateral meniscus and the intermeniscal ligament anteriorly have been used as soft tissue references for TT placement 10. It is the authors’ preference to use these bony and soft tissue landmarks for reference, as well as the patient’s native ACL footprint, as subtle anatomic differences arise from patient to patient.…”

Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction

“…It is therefore generally accepted that the aperture of the tibial tunnel should be located within the tibial footprint of ACL 1 2. At the same time, it is well known that the ACL footprint overlaps with the anterior lateral meniscal root (ALMR) and tibial tunnel reaming might damage the attachment of ALMR 3–7. Recent studies show that the ALMR inserts deep to the ACL footprint posteriorly and 63.2% of the ALMR attachment overlaps with 40.7% of the ACL tibial footprint 8 9.…”