Radiological evaluation of tunnel position in single bundle anterior cruciate ligament reconstruction in the Indian population and their clinical correlation

Abstract

Background: Proper positioning of osseous tunnels during single bundle arthroscopic ACL reconstruction, which gives reproducibly good clinical outcome, is a matter of concern. Little evidence is there correlating tunnel position in arthroscopic ACL reconstruction with their clinical outcome in Indian population. Our aim in this study was to examine if the radiological tunnel-positions were significantly associated to the clinical outcomes. Methods: ACL reconstruction was performed in 147 young patients with an isolated ACL tear. They were followed up prospectively for the next two years. Clinical assessment of each patient was done using the International Knee Documentation Committee (IKDC) evaluation form before surgery and at two years later the surgery. At the same time, the radiological assessment was done on standard digital radiographs. Results: Considering the anterior and posterior-most points on the Blumensaat's line as 0% and 100% respectively the average position of the femoral tunnel was at 84.8%. Similarly, the tibial tunnel was at 46.8% along the tibial plateau. On the coronal plane the average position of the tibial tunnel was at 45.6% point along the tibial plateau (measured from the medial-most point towards laterally). The mean position of the femoral tunnel in the coronal plane was at 43.2% along the broadest part of the distal femur (measured from the lateral extent). The average inclination angle of the graft measured 19.6 (along the coronal plane). Conclusion: Ideal clinical outcome was significantly associated with the placement of the femoral tunnel along the sagittal plane. Placement of the femoral tunnel should not be beyond the 85% mark along the Blumensaat's line from the anterior-most point. No correlation was established between clinical results and any of the remaining radiological parameters described above.

Accuracy of transportal femoral aimer in placement of femoral tunnel during arthroscopic anterior cruciate ligament reconstruction: An observational study

“…In this study, the mean tunnel location in AP plane (lateral X-ray view) was at 80.01% [Table 3], which was similar to the study of Pinczewski et al and Debnath et al [11,19] In contrast to our study, Nema et al placed femoral tunnels at an average of 69.41% ± 10.77% posterior along the Blumensaat's line, which was more anterior to ours. [20] While in Pinczewski et al study, the midpoint of the femoral tunnel was located at a mean of 86% ± 5% posteriorly along Blumensaat's line, which was more posterior than our study.…”

“…[9] Studies have recommended placing the femoral tunnel at least 60-86% posterior along the Blumensaat's line. [11,[19][20][21] Considering this fact, we can conclude that 84% of tunnel made by combination of eyeballing and femoral offset aimer are correctly placed.…”

Influência dos parâmetros do túnel e do ângulo de inclinação do enxerto no desfecho clínico e radiológico no acompanhamento de longo prazo após a reconstrução artroscópica do ligamento cruzado anterior

“…Debnath et al 21 did a radiological evaluation of the tunnel position in single-bundle ACLR in the Indian population and correlated with clinical outcome. They found that the “ideal clinical outcome” was significantly associated with placement of the femoral tunnel along the sagittal plane.…”

“…Debnath et al 21 fizeram uma avaliação radiológica da posição do túnel na RCLA de feixe único na população indiana e a correlacionaram ao desfecho clínico. Estes autores descobriram que o “desfecho clínico ideal” estava significativamente associado à colocação do túnel femoral ao longo do plano sagital.…”