Intertunnel Relationships in Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction

Abstract

These results will help to reduce the incidence of tunnel convergence in combined ACL and PLC reconstructions.

Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up

“…The described technique solves a classic problem of combined ACL and PLC reconstructions, which is the convergence of tunnels in the lateral femoral condyle. Studies on cadaver models have been conducted to obtain the best angle for the tunnels, aiming to prevent them from getting too close to each other and leading to weakening or even collision of the bone walls [9,14,23]. However, such situations not only demand an advanced surgical technique but are also subject to patients' anatomical variations.…”

“…Combined injuries of the anterior cruciate ligament (ACL) and posterolateral corner (PLC) account for approximately 11 % of all ACL injuries [14]. Although PLC injuries of type A according to Fanelli's classification [7] (i.e., PLC injuries with a slight increase in external rotation and without significant varus opening) can be treated conservatively [6], other injuries do not develop satisfactorily from a functional point of view and increase the likelihood of ACL reconstruction failure if not surgically treated [6,15].…”

“…Where such convergence does not occur, there may be bone weakening of the region due to the proximity of the constructed tunnels to one another [14,23].…”

Multiple Ligament Reconstruction Femoral Tunnels: Intertunnel Relationships and Guidelines to Avoid Convergence

“…32 Different angles have been suggested in the literature for both medial-sided 4,16 and lateral-sided reconstructions. 3,13,15,20,37 However, to our knowledge, there is no available literature concerning the optimal tunnel orientation for multiple knee ligament reconstructions of all 4 primary ligamentous structures: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posteromedial and posterolateral corners. The aim of our study was to determine the optimal tunnel orientation in the femur when performing multiple ligament knee reconstructions to achieve the desired tunnel length while avoiding tunnel convergence.…”

Morphometry of the fibular collateral ligament: Anatomic study with comprehensive review of the literature

“…FCL injuries have also been reported to be associated with superficial fibular nerve injuries, cartilage injuries, and meniscal injuries 25%, 12%, and 27% of the time, respectively (Hergenroeder, ). Due to the frequency of these injuries and their need for surgical correction, the role of the FCL in stabilizing the knee joint has gained considerable attention (Belvedere et al, ; Wilson et al, ; Kim et al, ).…”