Factors Influencing Graft Impingement on the Wall of the Intercondylar Notch After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

The tibial bone tunnel position in the coronal orientation was most likely associated with wall impingement. Considering that tibial bone tunnels are generally created with the knee in 90° of flexion and move laterally as the knee extends because of screw-home movement, the AMB bone tunnel for the tibia should be positioned as medially as possible within its footprint to minimize the risk of wall impingement after anatomic double-bundle ACL reconstruction.

Comparison of artificial graft versus autograft in anterior cruciate ligament reconstruction: a meta-analysis

“…Extension loss was the most common complication in included studies and it might be associated with graft impingement and a formation of cyclops [39, 40]. Graft impingement was mainly caused by malposition of femoral bone tunnel and a “cyclops” was a fibrous nodule caused by proliferation of fibrovascular tissues similar to a healing scar after ACL reconstruction [41, 42]. The synthetic grafts were located in a non-anatomic but isometric placement while the autografts were usually located in an anatomic placement.…”

ACL double-bundle reconstruction with one tibial tunnel provides equal stability compared to two tibial tunnels

“…The same results were obtained for the anterior tibial translation with a combined rotatory load at 60° and 90°. When directly tunnels for a reconstruction with two separate bundles without risking anterior-notch or lateral-wall impingement [35] or confluence of the tunnels. The latter can be caused by intraoperative confluence at the joint line or by postoperative tunnel enlargement, as described by Siebold [31] in up to 41 % of cases.…”

Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study

“…Some previous studies have analyzed the femoral graft bending angle between femoral tunnel axis and graft at the femoral tunnel aperture in ACL reconstruction [12,16,18,23,26,27]. However, the relationship between femoral tunnel location and femoral graft bending angle has been little investigated.…”