Anatomic femoral tunnel creation during anterior cruciate ligament reconstruction using curved dilator system

Abstract

Purpose: Recently, tunnel placements in anatomic positions have been emphasized for successful restoration of knee function after anterior cruciate ligament (ACL) reconstruction. The anteromedial portal technique is considered to be more favorable than the transtibial technique for anatomic femoral tunnel placements; however, it has some technical disadvantages. To minimize these disadvantages, the authors developed the curved dilator system (CDS). The purpose of this study was to evaluate the femoral tunnel position, length, and intraoperative complications with CDS. Methods: Sixty-two consecutive patients who underwent ACL reconstruction with CDS were subjects of this study. The femoral tunnel was created using a 4.5 mm-diameter curved guide trocar and was widened in a step-by-step manner, increasing by 1 mm dilator diameter to match the graft with the knee flexed to slightly over 90 . Femoral tunnel positions were evaluated by the quadrant method from postoperative computed tomographic images. Femoral tunnel length was measured using the curved depth gauge during surgery. Complications such as posterior wall blowout and cartilage damage were checked intraoperatively. Peroneal nerve injury was observed during the hospital stay. Results: Femoral tunnel position was 32.7% + 5.4% and 39.1% + 5.9% in the superior-inferior and anterior-posterior positions, respectively. Femoral tunnel length was 39.2 + 4.1 mm. Damage to medial femoral condyle cartilage, posterior wall blowout, and peroneal nerve injury did not occur in any case. Conclusion: ACL reconstruction with CDS resulted in anatomic positioning of the femoral tunnel and sufficient femoral tunnel length without intraoperative complications.

Positioning Technique of the Fixed Knee in Hyperflexion for the Transportal Femoral Tunnel During Reconstruction of the Anterior Cruciate Ligament

“…They also conducted a cadaveric biomechanical study that compared femoral positioning with transtibial; they also compared the transportal and hybrid techniques, concluding that the hybrid technique results in femoral tunnel positioning that is very similar to positioning produced by the anatomical technique. 12 Lee et al 15 described the use of a curved femoral guide that assists in making the femoral tunnel in the anatomical position without hyperflexion. This guide reportedly reduces the risks inherent to the anatomical technique, which is performed conventionally.…”

“…This guide reportedly reduces the risks inherent to the anatomical technique, which is performed conventionally. 15 However, the use of arthroscopic guides requires a greater learning curve for their correct use, and these anatomical points, such as the "residents ridge," can be difficult to identify, especially for less-experienced surgeons and in cases of ACLR revision. 4 The use of a simple-handling L-positioner can be added to these other mentioned items as another important factor for the correct positioning and perforation of the femoral tunnel.…”

Feasibility and accuracy of orthopaedic surgical robot system for intraoperative navigation to locate bone tunnel in anterior cruciate ligament reconstruction

“…In particular, the accuracy of bone tunnel drilling is an important factor affecting the clinical outcomes of the procedure 2 . The anatomical area of the ACL growth insertion is considered to be an accurate reference location for bone tunnel drilling 3,4 . The traditional method of locating the bone tunnels uses handheld locators under an arthroscopic system; the advantage of this method is its ability to observe and locate the ACL attachment point.…”

A pioneer in sports medicine passed away

“…Dr Fu’s research has had major impact on our understanding of ACL anatomy and kinematics, and has helped to find better techniques to reconstruct an injured ACL. Researchers sought better ways to anatomically create femoral tunnels 6 and compared non-anatomic and anatomic techniques to optimally reconstruct the ACL. 7,8…”

“…Dr Fu's research has had major impact on our understanding of ACL anatomy and kinematics, and has helped to find better techniques to reconstruct an injured ACL. Researchers sought better ways to anatomically create femoral tunnels 6 and compared non-anatomic and anatomic techniques to optimally reconstruct the ACL. 7,8 A recent study titled 'The Top 100 Most Cited Articles on Anterior Cruciate Ligament Reconstruction: A Bibliometric Analysis' in the Orthopaedic Journal of Sports Medicine found that the most prolific co-author and first author was Freddie H. Fu, and the most productive institution was the University of Pittsburgh.…”