Positioning of the Femoral Tunnel for Arthroscopic Reconstruction of the Anterior Cruciate Ligament: Comparative Study of 2 Techniques

Abstract

. Positioning of the femoral tunnel for arthroscopic reconstruction of the anterior cruciate ligament: comparative study of 2 techniques. Clinics. 2007;62(5):613-8. OBJECTIVE:To compare the accuracy of positioning of the femoral tunnel in reconstructing the anterior cruciate ligament by means of 2 techniques: tibial tunnel and anteromedial portal. METHOD: Femoral tunnels were drilled in 20 knees from human cadavers by means of arthroscopy. Group I had the femoral tunnel drilled via a trans-tibial tunnel, and Group II via the anteromedial portal. Four variables were measured: A) posterior wall thickness; B) tunnel positioning at the notch; C) tunnel inclination in relation to the femoral axis; and D) distance between the wire guide exit and the lateral epicondyle. RESULTS: As above, respectively, A) 2.23 mm for group I and 2.36 mm for group II (P =.54); B) 25.5° for group I and 30.0° for group II (P =.23); C) 23.9° for group I and 32.0° for group II (P =.02); D) 7.8 cm for group I and 3.9 cm for group II (P <.001). CONCLUSIONS: Both techniques achieved the desired positioning for the femoral tunnel entrance and satisfactory thickness for the posterior cortex. Drilling via the anteromedial portal may provide greater protection against rupture of the posterior wall.

Design and level of evidence of studies published in two Brazilian medical journals recently indexed in the ISI Web of Science database

“…The journal Clinics contained a large number of ex-perimental studies (n = 14), mostly using rat models, but also one study using a pig model (analyzing respiratory dysfunction in relation to sepsis) 23 and three experimental studies on the knees of human cadavers. [24][25][26] For both journals, the most common clinical questions addressed in the articles related to the prevalence, frequency or associations between variables, which were answered using cross-sectional studies. There were only 25 cohort studies (8.6% of all the articles), and a single case-control study.…”

Transtibial Versus Independent Drilling Techniques for Anterior Cruciate Ligament Reconstruction

“…33,42,59,78 In the 3 cadaveric studies reporting this outcome, independent drilling consistently resulted in greater femoral tunnel obliquity than TT drilling. 4,9,39 Posterior wall blowout is a well-known contributor to ACL reconstruction failure, particularly when intraosseous fixation is used. 55 While 1 study found no significant difference in the posterior femoral tunnel wall thickness between the TT and AMP drilling techniques, all other studies demonstrated thinner posterior walls and a higher incidence of posterior blowout with the independent drilling technique.…”

Knee stability, athletic performance and sportspecific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques

“…Other Authors found no differences in terms of tunnel placement with the two techniques [37][38][39] . Rue demonstrated that an anatomical placement of the femoral tunnel could be obtained also with a TT approach 40 and Musahl et al 5 demonstrated that neither tunnel placement between the anatomical origin of the ACL and the most isometric point fully restored knee kinematics, but an anatomic graft placement resulted in a kinematics similar to the normal knee joint.…”