Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study

Arnold, Markus; Kooloos, J.G.M.; Kampen, A. van

doi:10.1007/s001670100198

Cited by 243 publications

(244 citation statements)

References 22 publications

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“…Difficulties placing the femoral tunnel in the ACL footprint using single-incision transtibial tunnel techniques have been reported [5,9,29]. Arnold et al [5] reported the anatomic attachment site of the ACL could not be reached with a femoral aiming guide through a standard tibial tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…Arnold et al [5] reported the anatomic attachment site of the ACL could not be reached with a femoral aiming guide through a standard tibial tunnel. The closest position that could be reached was at the margin of the anatomic attachment site, deep and high in the notch [5]. In the current study, we also had difficulty placing the guide pin near the center of the ACL attachment using the transtibial technique in every specimen.…”

Section: Discussionmentioning

confidence: 99%

“…Frequently, the grafts are placed too far anteriorly on the femur, resulting in a vertically oriented graft [5,9,16,25,29,56]. Several in vitro studies suggest a graft placed too far anteriorly on the femur results in excessive tension in the graft in flexion, which could lead to graft failure [8,56].…”

Section: Introductionmentioning

confidence: 99%

“…The transtibial technique, in which the femoral tunnel is drilled through the tibial tunnel, is commonly used in ACL reconstruction [5,19,29,46]. However, several studies have suggested that the transtibial technique might not be able to center the graft near the anatomic center of the ACL, owing to constraints imposed by the tibial tunnel [5,9,29].…”

Section: Introductionmentioning

confidence: 99%

“…However, several studies have suggested that the transtibial technique might not be able to center the graft near the anatomic center of the ACL, owing to constraints imposed by the tibial tunnel [5,9,29]. Techniques where the femoral tunnel is placed independently of the tibial tunnel might allow for better placement of the femoral tunnel.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

Kaseta

DeFrate

Charnock

et al. 2008

Clinical Orthopaedics &Amp; Related Research

140

143

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

Kaseta

DeFrate

Charnock

et al. 2008

Clinical Orthopaedics &Amp; Related Research

140

143

View full text Add to dashboard Cite

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Effects of ACL graft placement on in vivo knee function and cartilage thickness distributions

DeFrate

2017

J. Orthop. Res.

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Injuries to the anterior cruciate ligament (ACL) frequently lead to early-onset osteoarthritis. Despite advancement in surgical techniques, ACL reconstruction has a limited ability to prevent these degenerative changes. While previous studies have investigated knee function after ACL reconstruction, in vivo investigations of the effects of graft placement on in vivo joint function and cartilage health are limited. This review presents a series of studies that used novel imaging and 3D modeling techniques to determine the in vivo placement of the ACL graft on the femur using two different ACL reconstruction techniques. These techniques resulted in two distinct graft placement groups: one where the ACL was placed anatomically near the center of the native ACL footprint and another where the graft was placed anteroproximally on the femur, centered outside the ACL footprint. We quantified the effects of graft placement on graft deformation during in vivo loading and how these variables affected knee motion. Finally, we quantified whether femoral placement of the graft affected cartilage thickness. Our results demonstrate that achieving anatomic graft placement on the femur is critical to restoring native ACL function and normal knee kinematics. Knees with grafts that more closely restored normal ACL function, and thus knee motion, experienced less focal cartilage thinning than did those that experienced abnormal knee motion. These results suggest that achieving anatomic graft placement is a critical factor in restoring normal knee motion and potentially slowing the development of degenerative changes after ACL reconstruction.

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