Ideal tibial tunnel length for endoscopic anterior cruciate ligament reconstruction

Olszewski, AD; Miller, '; Ritchie, Joseph R.

doi:10.1016/s0749-8063(98)70114-8

Cited by 47 publications

(30 citation statements)

References 8 publications

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“…However, the graft angle in the sagittal plane is quite different, ranging from 35°to 60°, and the graft angle in the coronal plane also varies between the 10 and 11 o'clock position for the right knee [4,6,10,14,24,29,32,37]. It is believed that the anatomic graft angle and placement should provide improved biomechanical stability and reproduce the normal kinematics of the native ACL in all planes of the motion.…”

Section: Introductionmentioning

confidence: 99%

Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study

Ahn

Lee

Yoo

et al. 2007

Knee Surg Sports Traumatol Arthr

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The aims of this study were to quantify the angle and placement of an anterior cruciate ligament (ACL) grafted with a single incision ACL reconstruction technique using postoperative magnetic resonance imaging (MRI), and to compare the results with those with a native ACL. Between February 1996 and May 2004, 96 consecutive patients, who had undergone postoperative MRI of the knee followed by an arthroscopically assisted ACL reconstruction with either a hamstring tendon or bone-patellar tendon-bone (BTB) autograft, were enrolled in this study. The femoral tunnel was drilled using the transtibial technique. The patients were divided into two groups; the hamstring tendon graft group (group H; 50 patients) and the BTB graft group (group B; 46 patients). All the patients including both groups in this study underwent postoperative MRI and were followed up for a minimum of 2 years. The control group (group C) consisted of 50 patients whose meniscus tear had been operated on by arthroscopy and whose ACL was intact. The orientation of the ACL ligament or graft was measured using three different methods: the sagittal ACL angle, the ACL-Blumensaat line angle, and the coronal ACL angle. The mean sagittal ACL angle in group C (58.7 +/- 3.8 degrees ) was significantly lower than in groups H (64.6 +/- 4.2 degrees ) and B (71.3 +/- 6.0 degrees ). The mean ACL-Blumensaat line angle in group C (8.6 +/- 3.6 degrees ) was also significantly lower than in groups H (12.8 +/- 5.2 degrees ) and B (18.0 +/- 5.3 degrees ). The mean coronal ACL angle in group C (65.9 +/- 4.4 degrees ) was lower than that in groups H (73.5 +/- 2.4 degrees ) and B (75.2 +/- 2.9 degrees ). The grafted ACL of the hamstring tendon and BTB grafts on the postoperative MRI showed a significant vertical angle in the coronal and sagittal plane compared with the native ACL. In the sagittal plane, the hamstring tendon graft was positioned more obliquely than the BTB graft, which had a larger angle of the tibial tunnel, in an attempt to prevent a graft-tunnel mismatch. The postoperative MRI study showed that the more horizontally the angle of the tibial tunnel can be placed in a single incision ACL reconstruction, the more efficiently it can produce a graft closer to the native ACL.

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Section: Introductionmentioning

confidence: 99%

Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study

Ahn

Lee

Yoo

et al. 2007

Knee Surg Sports Traumatol Arthr

View full text Add to dashboard Cite

show abstract

“…Creating tibial tunnels using a guide set at a constant angle without regard to the patellar tendon length has been reported to lead to a higher incidence of graft-tunnel mismatch. 34 Both direct and indirect methods of tibial tunnel placement are based on the same fundamental principles: (1) The bone-tendon junction of the femoral bone plug is positioned at the entrance to the femoral tunnel. This eliminates the need to take into account the length of the femoral bone block when determining the appropriate tibial tunnel length.…”

Section: Graft-tunnel Mismatchmentioning

confidence: 99%

“…(4) The combined length of the tibial bone plug and patellar tendon should equal the length of the tibial tunnel plus the intra-articular distance. 34 The direct method of tibial tunnel placement uses a mathematical formula based on a set of known or assumed measurements 35,36 (Fig 11). The required variables include the patellar tendon length (N), the tibial bone plug length (TBT), the intra-articular distance (IAD), and the tibial tunnel length (TT).…”

Section: Graft-tunnel Mismatchmentioning

confidence: 99%

“…It is an assumed value, with various authors reporting values ranging from 23 to 30 mm long. [34][35][36] The tibial tunnel length is the unknown value:…”

Section: Graft-tunnel Mismatchmentioning

confidence: 99%

“…Used alone, the direct method has been shown to be more accurate. 34 Another factor to consider in these calculations is the obliquity of the tibial tunnel at its extra-articular opening. Some surgeons add or subtract 5 mm to their calculations to compensate for this obliquity.…”

Section: Graft-tunnel Mismatchmentioning

confidence: 99%

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