Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

Abstract

PurposeThe object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees.Materials and MethodsThe centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured.ResultsIn four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel.ConclusionThe technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.

Anatomical Study of the Posterolateral Ligament Complex of the Knee: LCL and Popliteus Tendon

“…[13][14][15][16] Thus, using a distance of 18.5 mm between the femoral insertions of the PT and the LCL may not be adequate for anatomical reconstruction of the PLC in smaller knees. Constructing tunnels that are very close to each other, i.e., with less than 2 mm of bone bridge, to reproduce the exact anatomical origins of the LCL and PT, can lead to surgical complications such as tunnel confluence, graft fixation failure, and subsequent instability and failed ligament reconstruction, 17,18 especially when multiple femoral tunnels are used in cases of multiligament lesions. Thus, the primary objective of this study is to analyse the distances between the femoral insertions of the PT and the LCL through dissections of cadaveric specimens in a mixed non-Caucasian population to assess whether the distances are comparable to findings in the literature.…”

A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction

“… 12 In addition, rupture patterns of AM and PL bundles vary widely, and depend on whether injuries result from mild elongation or severe stretching. Based on this anatomically and biomechanically orientated DB concept, researchers have focused recently on anatomical DB ACL reconstruction 7 13 14 15 16 17 and the treatment of symptomatic partial ACL tears using individual bundle reconstruction techni-ques. 5 18 19 However, surgeons are posed with a dilemma as to how to evaluate the viabilities and functionalities of remaining bundles and how to determine which bundle should be preserved or sacrificed.…”