Coverage of the Anterior Cruciate Ligament Femoral Footprint Using 3 Different Approaches in Single-Bundle Reconstruction

Abstract

To improve the coverage of the native femoral footprint with a single-bundle graft, in addition to the entry point it may also be necessary to consider the orientation of the drilling to increase the dimensions of the area while respecting the anatomic constraints of the femoral bone and graft geometry.

Short-Term Study of the Outcome of a New Instrument for All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction

“…33,34 A number of researchers have suggested that anteromedial approaches or outside-in approaches (or both) can yield tunnels in more anatomic positions than transtibial approaches. [35][36][37][38][39][40][41][42] In an anatomic study of ACL attachment locations using 20 human cadaveric knees, Zantop et al 25 reported that the center of the femoral AM bundle was located along the Blumensaat line at a distance of 18.5% of the sagittal diameter of the femur and at 22.3% of the height measured perpendicular to the Blumensaat line. However, other studies reported these respective parameters with considerable variability, as follows: 26.4% and 25.3% in a radiographic study of 7 cadaveric specimens, 30 21% and 24% in an anatomic study of 22 cadaveric knees with intact ACLs, 43 21.7% and 33.2% in a 3D CT study of 8 cadaveric knees, 31 and 27.7% and 16.3% in a study of 71 patients who underwent ACL reconstruction.…”

Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of the Anteromedial Portal and Outside-in Techniques

“…Several studies have investigated the position of the femoral tunnel in patients who underwent conventional transtibial and anatomic ACL reconstruction15,21–23). The transtibial technique appears to cause a graft that is oriented anteriorly with limited ability to restore the oblique orientation of the ACL or normal knee stability2,9).…”

General Technical Consideration in Arthroscopic Anterior Cruciate Ligament Reconstruction

“…• Anatomic tunnel placement according to native femoral ACL footprint (compared to TT technique) [ 14 ].…”