Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

Abstract

Grafts placed too anteriorly on the femur are reportedly a common cause of failure in anterior cruciate ligament reconstruction. Some studies suggest more anatomic femoral tunnel placement improves kinematics. The ability of the transtibial technique and a tibial tunnel-independent technique (placed transfemorally outside-in) to place the guide pin near the center of the femoral attachment of the anterior cruciate ligament was compared in 12 cadavers. After arthroscopic placement of the guide pins, the femur was dissected and the three-dimensional geometry of the femur, anterior cruciate ligament footprint, and positions of each guide pin were measured. The transtibial guide-pin placement was 7.9 ± 2.2 mm from the center of the footprint (near its anterior border), whereas the independent technique positioned the guide pin 1.9 ± 1.0 mm from the center. The center of the footprint was within 2 mm of an anteroposterior line through the most posterior border of the femoral cartilage in the notch and a proximodistal line through the proximal margin of the cartilage at the capsular reflection. More accurate placement of the femoral tunnel might reduce the incidence of graft failure and might reduce long-term degeneration observed after reconstruction although both would require clinical confirmation.

Nonanatomic Tunnel Position in Traditional Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction Evaluated by Three-Dimensional Computed Tomography

“…1, C). These findings are consistent with prior cadaver studies that evaluated tunnel position in traditional transtibial anterior cruciate ligament reconstruction [5][6][7][8] . In those studies, the tunnels were drilled during arthroscopy or in an open fashion and were evaluated postoperatively during dissection.…”

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

“…Drilling can be undertaken through an accessory AM portal or with our TransLateral technique. 30 ACL footprint anatomy has been defined, 42 and identification of the mid-bundle position on the femur can be achieved with the direct measurement technique, which has been validated. 32 Biomechanical testing has shown that single-bundle anatomic positioning confers advantages over traditional graft placement, but further improvements may be obtained by double-bundle reconstruction.…”

Incidence of the Remnant Femoral Attachment of the Ruptured ACL

“…In a recent study by Kaseta et al [11], more anatomic placement of the femoral tunnel was achieved using the femoral footprint as a landmark than with the over-the-top positioning guide, which resulted in femoral tunnel placement that was typically too anterior.…”