Femoral Tunnel Placement in Single-Bundle Anterior Cruciate Ligament Reconstruction

Rue, John-Paul; Ghodadra, Neil; Bach, Bernard R.

doi:10.1177/0363546507311093

Cited by 82 publications

(34 citation statements)

References 41 publications

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“…In an attempt to reduce the femoral tunnel obliquity using the transtibial technique, Rue et al21) moved the starting point of the tibial tunnel more proximally and medially than that in the conventional method and performed a 10- or 2-o’clock femoral tunnel placement. However, the limitations of their method included possible damage to the medial collateral ligament and pes anserinus, and difficulty to ensure firm fixation to the tibia due to the short tibial tunnel length.…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

Jeon

Choi

Park

et al. 2017

Knee Surg Relat Res

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PurposeThe purpose of this study was to evaluate the mid-term outcomes of anatomic anterior cruciate ligament (ACL) reconstruction using two anteromedial (AM) portals by comparing with short-term follow-up results.Materials and MethodsFifty patients who were treated by ACL reconstruction using a two AM portal technique were evaluated retrospectively. The follow-up period was at least 5 years. The mean follow-up period was 68.5±13.9 months. The mid-term clinical outcomes were compared with short-term (≥12 months) results. For the assessment of knee stability, anterior tibial translation was evaluated using the Lachman test and the KT-2000. Rotational stability was evaluated using pivot shift test. For clinical assessment, the Lysholm and International Knee Documentation Committee scores were used.ResultsThe average anterior translation was 2.1±1.4 mm at the short-term follow-up and 2.8±1.8 mm at the mid-term follow-up. Stability and midterm clinical outcomes were not significantly improved compared to the short-term follow-up results. At the mid-term follow-up, anteroposterior (AP) instability assessed by the KT-2000 was slightly increased, but still acceptable. On the other clinical physical evaluation, there was no statistically significant difference.ConclusionsThe short-term and mid-term outcomes of ACL reconstruction using the two AM portal technique were not significantly different except for AP stability although the value was less than 3 mm at both follow-ups. Therefore, this operative technique could be considered a satisfactory alternative for ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

Jeon

Choi

Park

et al. 2017

Knee Surg Relat Res

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“…This position was maintained for the same femoral tunnel location in all groups. The femoral aiming guide was rotated laterally so that the femoral tunnel could be placed more anatomically12,13). Finally, a 2.4-mm guide pin with a suture eyelet was inserted, and the femoral tunnel was drilled.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have suggested modifications to the coronal plane alignment of the tibial tunnel in the transtibial technique for accurate femoral tunnel positioning and minimal errors4,6,10–12). However, the literature is lacking on the effect of variation in the sagittal plane angle of the tibial tunnel in relation to the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in ACL reconstruction using the modified transtibial technique.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A RandomizedIn VivoStudy

Kim

Tawonsawatruk

Woon

et al. 2017

Knee Surg Relat Res

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PurposeThe effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG).Materials and MethodsNinety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge.ResultsThe TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm.ConclusionsThis study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.

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“…In the 1990s, two-dimensional anatomical scales, such as the “clock-face” reference and quadrant method, were developed as a fixed and universal scaling method to describe the anatomical location of the ACL insertion site and graft placement. The “clock-face” reference has been utilized for referring the coronal position of the ACL insertion site and graft placement [27–29]. This reference system is able to be adopted for arthroscopic images [30].…”

Section: Progression Of the Imaging Technology For The Acl Anatomymentioning

confidence: 99%

Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

Hoshino

Kim

2012

Anatomy Research International

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Anatomic study related to the anterior cruciate ligament (ACL) reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D) to three-dimensional (3D) image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction.

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Femoral Tunnel Placement in Single-Bundle Anterior Cruciate Ligament Reconstruction

Cited by 82 publications

References 41 publications

Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A RandomizedIn VivoStudy

Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

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