Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Elazab, Ashraf; Lee, Yong Seuk; Kang, Seo Goo

doi:10.1016/j.eats.2015.10.001

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…2A, B). 15,16 The arthroscope was introduced via the PM portal and showed transseptal portal, thereby the opened compartments and anatomical structures could be evaluated (►Fig. 2C, D).…”

Section: Transseptal Portal In Acl Femoral Tunnelingmentioning

confidence: 99%

“…[9][10][11][12] Therefore, techniques are being used to attain both aims such as posterolateral (PL) viewing with a 70-degree scope and transseptal portal viewing. [13][14][15][16] However, a 70-degree scope could show some distorted view due to its oblique view displacement. 13 In posterior cruciate ligament (PCL) reconstruction, the femoral footprint of the PCL could be seen easily without sacrificing the remnant PCL.…”

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Different Strategies in Making Transseptal Portal for the Different Purposes

et al. 2019

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AbstractThe purpose of this study was to find the most suitable and safe position of the transseptal portal in anatomic anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions. The hypothesis of this study was that area and position of the transseptal portal are different between ACL and PCL reconstructions for the observation of native footprint. A matched-pair comparison study was conducted on the arthroscopic images of 100 consecutive patients who underwent ACL reconstruction and 50 consecutive patients who underwent PCL reconstruction. The transseptum was divided into six compartments. The opened compartments for each surgery were then evaluated to find which anatomical structures are well seen. The anterior middle and upper parts were necessary for the ACL reconstruction, whereas middle and lower portions of the anterior and posterior compartments were necessary for the PCL reconstruction. A larger opening was necessary for PCL reconstruction than that for ACL reconstruction. The ACL posterior one-third, ACL femoral attachment, and apex of the deep cartilage margin (DCM) were viewed in 100% of the patients during ACL reconstruction. The PCL posterior one-third, PCL tibial attachment, PCL fovea margin, and medial meniscus around posterior margin were always viewed during PCL reconstruction. The anterior part of the septum, from the middle to the upper portions of the transseptum, was necessary to be opened for visualization of the femoral footprint and DCM of the lateral femoral condyle during ACL reconstruction. The anterior and posterior parts of the septum, from the middle to the lower portions of the transseptum, were necessary for excellent visualization of the PCL tibial footprint during PCL reconstruction. These paths of the transseptal portal for each surgery will help surgeons obtain both anatomic footprint restoration and maximal remnant preservation through the most suitable and safe means. This is a case–control study; level of evidence is 3.

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“…2A, B). 15,16 The arthroscope was introduced via the PM portal and showed transseptal portal, thereby the opened compartments and anatomical structures could be evaluated (►Fig. 2C, D).…”

Section: Transseptal Portal In Acl Femoral Tunnelingmentioning

confidence: 99%

mentioning

confidence: 99%

Different Strategies in Making Transseptal Portal for the Different Purposes

et al. 2019

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“…Although ACL anatomy has been described by use of radiographic and cadaveric measures, it is important to understand the anatomy to easy visualize the arthroscopic landmarks. 7 , 8 , 9 , 16 , 24 , 25 Anatomic placement of the femoral and tibial tunnels is crucial to the success of ACL reconstruction. 1 , 2 , 3 , 4 , 19 Although during ACL reconstruction the anatomic positioning is objectified, the maintenance of the bone integrity of the tunnels created is not always guaranteed.…”

Section: Discussionmentioning

confidence: 99%

A Femoral Tunnel View Test During ACL Reconstruction

Temponi

Soares

Júnior

2017

Arthroscopy Techniques

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Despite technologic advances in the surgical techniques for anterior cruciate ligament (ACL) reconstruction, some patients continue to have violation of the femoral cortex, commonly referred to as wall blowout. These posterior or lateral cortical breaches lead to loss of graft containment and subsequent difficulty with graft fixation. If this intraoperative error is not promptly recognized and treated, the graft is at an increased risk of premature failure. Thus, in these situations, recognizing the complication and knowing strategies for alternative or salvage fixation are of importance. This article details a simple tunnel view test realized during ACL reconstruction that would enable determining the integrity and depth of the femoral tunnel. The femoral tunnel view test is a technically straightforward and quick test able to obtain a superior view of patient anatomy to facilitate accurate tunnel integrity evaluation during ACL reconstruction.

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“…[12][13][14][15] An alternative approach is to locate the femoral tunnel according to the ligament remnant; however, it can be difficult to accurately identify the ACL footprint with an anterior arthroscope when the remnant is preserved. 16 It has been reported that the femoral tunnel can be located accurately with the quadrant method, and this can be achieved intraoperatively by using fluoroscopy. [17][18][19] However, repeated fluoroscopy is needed during surgery, and the bone can be damaged during readjustment of the position, affecting the location of the guide needle.…”

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Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

et al. 2021

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The techniques available to locate the femoral tunnel during anterior cruciate ligament (ACL) reconstruction have notable limitations. To evaluate whether the femoral tunnel center could be located intraoperatively with a ruler, using the posterior apex of the deep cartilage (ADC) as a landmark. This retrospective case series included consecutive patients with ACL rupture who underwent arthroscopic single-bundle ACL reconstruction at the Department of Orthopedics, Beijing Tongren Hospital between January 2014 and May 2018. During surgery, the ADC of the femoral lateral condyle was used as a landmark to locate the femoral tunnel center with a ruler. Three-dimensional computed tomography (CT) was performed within 3 days after surgery to measure the femoral tunnel position by the quadrant method. Arthroscopy was performed 1 year after surgery to evaluate the intra-articular conditions. Lysholm and International Knee Documentation Committee (IKDC) scores were determined before and 1 year after surgery. The final analysis included 82 knees of 82 patients (age = 31.7 ± 6.1 years; 70 males). The femoral tunnel center was 26 ± 1.5% in the deep-shallow (x-axis) direction and 31 ± 3.1% in the high-low (y-axis) direction, close to the “ideal” values of 27 and 34%. Lysholm score increased significantly from 38.5 (33.5–47) before surgery to 89 (86–92) at 1 year after surgery (p < 0.001). IKDC score increased significantly from 42.5 (37–47) before surgery to 87 (83.75–90) after surgery (p < 0.001). Using the ADC as a landmark, the femoral tunnel position can be accurately selected using a ruler.

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Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Cited by 10 publications

References 16 publications

Different Strategies in Making Transseptal Portal for the Different Purposes

Different Strategies in Making Transseptal Portal for the Different Purposes

A Femoral Tunnel View Test During ACL Reconstruction

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

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