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

Jeon, Young-Chan; Choi, Sung Wook; Park, Jae Young; Yoon, Jin‐San; Shin, Jung Sub; Kim, Myung Ku

doi:10.5792/ksrr.15.061

Cited by 10 publications

(8 citation statements)

References 24 publications

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“… 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. 18 The advantages of the described test are that it is technically straightforward to learn and the surgeon is quickly able to obtain a superior view of patient anatomy to facilitate accurate tunnel integrity evaluation, despite this is not a common complication.…”

Section: Discussionmentioning

confidence: 99%

“…Improvements in clinical and functional results of anterior cruciate ligament (ACL) reconstruction have been observed after anatomic reconstruction is performed. 1 , 2 , 3 , 4 For anatomic ACL reconstruction, there is a need to place both femoral and tibial tunnels in the center of the respective footprints, respecting the original anatomy. 1 , 5 Knowledge of the anatomic position of ACL attachments can improve the correct positioning and placement of the tunnel and graft.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Femoral Tunnel View Test During ACL Reconstruction

Temponi

Soares

Júnior

2017

Arthroscopy Techniques

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“…While single bundle ACLR is the most preferred procedure, the transportal approach also helps double-bundle ACLR considering the direct access to the ACL femoral footprint and better control over drilling tracks [3]. However, the medial arthroscopic portal for single-bundle ACLR has not been uniformly placed in different studies [4][5][6]. Some authors have advocated for a medial portal close to the patellar tendon [2,7,8].…”

Section: Introductionmentioning

confidence: 99%

Effect of Tunnel Drilling Portal on Femoral Tunnel Entry Aperture’s Location in Arthroscopic Anterior Cruciate Ligament Reconstruction

Ghaffar¹,

Arora²,

Agrawal³

et al. 2022

Cureus

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IntroductionTransportal techniques for femoral tunnel drilling have the advantage of anatomical anterior cruciate ligament reconstruction, which was earlier difficult to achieve through transtibial femoral tunnels. However, the medial arthroscopic portal used for femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction (ACLR) has not been uniformly placed in different studies. Therefore, we performed a computed tomography-based analysis to compare the femoral tunnel entry aperture of the ACLR cases that used the standard AM portal and those using a far medial portal for femoral tunnel drilling. MethodsWe retrospectively reviewed computed tomography images of patients who underwent isolated singlebundle ACLR in our institute with either standard anteromedial portal or the far medial portal used for the femoral tunnel drilling. The femoral tunnel aperture's depth and height, measured using the quadrant method, were compared between the two portal methods. ResultsA total of forty-two case records were reviewed, sixteen belonging to standard anteromedial portal technique and twenty-six belonging to far medial portal technique. The tunnels created through the far AM portal were significantly shallower (more anterior) and inferior than the standard AM portal-created femoral tunnels. ConclusionThe choice of drilling portals can influence transportal femoral tunnel drilling. A tendency towards anterior and inferior positioning of the femoral tunnel entry aperture has been observed when a far medial arthroscopic portal is used for femoral tunnel drilling. Therefore, care must be taken to ensure that the drilling guide pin position does not change when the reamer is passed over it.

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“…There are several types of rotatory instability of the knee joint including posterolateral rotatory instability (PLRI) due to posterolateral corner (PLC) injury, internal tibial rotatory instability due to anterolateral ligament (ALL) injury, and anteromedial instability. The obliquity of a reconstructed anterior cruciate ligament (ACL) could also affect rotatory instability and long-term outcome 1) . Therefore, the measurement of rotation is important to evaluate these problems of the knee joint.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Knee Rotation Angles Using a Smartphone Application: An Experimental Study of Porcine Knees

Kim

Lee

Shin

et al. 2017

Knee Surg Relat Res

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PurposeThis study evaluated the efficacy of a smartphone application in the measurement of rotation angles in porcine knees.Materials and MethodsTwo K-wires were fixated to the femoral condyle and anterior tibial crest of 10 porcine legs. The angle created between the K-wires with an external rotation force applied was measured on a photograph and defined as the true angle. The same force was applied to the legs placed on a splint with a smartphone attached to the plantar side. The angle presented on a smartphone application was determined as the measured angle. The differences between the true and measured angles in 30° and 90° knee flexion and differences in measured angles depending on the status of the popliteus tendon were compared.ResultsIn the intact knees, the mean true angles in 30° and 90° flexion were 20.5°±1.4° and 19.1°±1.3°, respectively, and the mean measured angles in 30° and 90° flexion were 21.1°±0.9° and 18.6°±1.6°, respectively. When the popliteus tendon was cut, the mean true angles in 30° and 90° flexion were 31.4°±1.1° and 38.5°±2.5°, respectively, and the mean measured angles in 30° and 90° flexion were 31.8°±1.2° and 39.2°±2.8°, respectively. The differences between the true and measured angles were not significant. The measured angle increased by more than 10° after cutting of the popliteus tendon in both 30° and 90° flexion.ConclusionsUsing a smartphone application could be a good method of measuring knee rotation.

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

Cited by 10 publications

References 24 publications

A Femoral Tunnel View Test During ACL Reconstruction

A Femoral Tunnel View Test During ACL Reconstruction

Effect of Tunnel Drilling Portal on Femoral Tunnel Entry Aperture’s Location in Arthroscopic Anterior Cruciate Ligament Reconstruction

Measurement of Knee Rotation Angles Using a Smartphone Application: An Experimental Study of Porcine Knees

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