Positioning of the Tibial Tunnel After Single-Bundle ACL Primary Reconstruction on 3D CT scans: A New Method

Abstract

Purpose To assess intra-articular tunnel aperture positioning after primary anterior cruciate ligament (ACL) reconstruction with either the reference standard method or the intercondylar area method in a single center using 3-dimensional (3D) computed tomography (CT) scans and to evaluate the intra-articular position of the tibial tunnel relative to the ACL footprint. Methods 3D CT scans were performed after 120 single-bundle primary ACL reconstruction cases. The center of the tibial tunnel aperture and the center of the ACL footprint were referenced on axial views of the tibial plateau in the anteroposterior (AP) and mediolateral (ML) planes according to a centimetric grid system including the whole plateau (reference standard). This was compared with a grid system based on intercondylar area bony anatomy. The posterior aspect of intertubercular fossa, anterior aspect of the tibial plateau, medial intercondylar ridge, and crossing point between lateral intercondylar ridge and posterior margin were used as landmarks to define the grid. Results According to the reference standard method, the center of the tibial tunnel aperture was positioned 0.57 ± 2.62 mm more posterior and 0.67 ± 1.55 mm more medial than the center of the footprint. According to the intercondylar area method, the center of the tibial tunnel aperture was positioned 1.32 ± 2.74 mm more posterior and 0.66 ± 1.56 mm more medial than the center of the footprint. The position difference between the center of the tunnel aperture and the center of the footprint were statistically correlated for both grids, with r = –0.887, P < .001 for AP positioning and r = 0.615, P < .001 for ML positioning. Conclusion This intercondylar area method using arthroscopic landmarks can be used to assess tunnel placement on 3D CT scans after ACL reconstruction. Level of Evidence III, retrospective comparative study.

Rate of Tibial Tunnel Malposition Is Not Changed by Drilling Entirely Within the Stump of Preserved Remnants During ACL Reconstruction: A Prospective Comparative 3D-CT Study

“…Specifically, ML and AP tibial plateau widths are not measured during surgery, and instead, intraoperative landmarks are utilized. Recently, Cremer et al 7 attempted to address this issue by evaluating postoperative tunnel position using a grid positioned according to the intracondylar bony landmarks seen intraoperatively. Although the technique is of interest, there are currently limited data to support its validity and further study is needed.…”

Double-bundle Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring-bone Graft: a Long-term Follow Up

“…Single-bundle and double-bundle anatomic anterior cruciate ligament reconstruction (ACLR) are common techniques for ACL injuries. In recent the decade, single-bundle anatomic ACLR has been widely recognized because of its similar clinical effect and easier surgical techniques than double-bundle anatomic ACLR [1][2][3][4]. However, it is still controversial whether double-bundle or single-bundle reconstruction will provide superior clinical results.…”