The Ability of 3 Different Approaches to Restore the Anatomic Anteromedial Bundle Femoral Insertion Site During Anatomic Anterior Cruciate Ligament Reconstruction

Kopf, Sebastian; Pombo, Mathew W.; Shen, Wei; Irrgang, James J.; Fu, Freddie H.

doi:10.1016/j.arthro.2010.07.010

Cited by 72 publications

(70 citation statements)

References 22 publications

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“…Currently, OI and TP techniques are popular techniques for drilling femoral tunnels in anatomic ACL reconstruction [8,9,12,20,25,29,30,32,34,51,54,56], and modified TT technique has been also reported to achieve anatomic placement of the grafts within ACL footprint [14,58,59]. Recent studies on GBA evaluated by postoperative CT have reported that OI technique resulted in more steep GBA than in TP technique, with about 80° GBA by OI technique [23,40,50], and these results were similar to our findings at full extension.…”

Section: Discussionsupporting

confidence: 58%

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction

Tashiro

Irarrázaval

Osaki

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionsupporting

confidence: 58%

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction

Tashiro

Irarrázaval

Osaki

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed outpatient orthopaedic surgeries in the United States and is typically performed in the setting of sports injuries [18,24,26,30,31]. Because many patients who undergo these procedures are young and active, surgical stabilization of the knee is an attractive option [1,18,25,41].…”

Section: Introductionmentioning

confidence: 99%

“…Anatomic placement is considered optimal to provide maximum stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel [1,11,23,26]; however, the results of this approach have sometimes been disappointing because a more vertical graft could limit rotational stability [37,45]. Some have therefore suggested that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial drilling portal [8,13,20].…”

Section: Introductionmentioning

confidence: 99%

“…Some have therefore suggested that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial drilling portal [8,13,20]. Most studies report that the anatomic tibial and femoral footprints are more frequently restored using this anteromedial (AM) technique when compared with the transtibial (TT) technique [1,26,44,46]. However, it is not clear if the footprints reproduced with the AM technique equate to improved knee stability as compared with the stability of the intact contralateral knee when compared with the TT technique.…”

Section: Introductionmentioning

confidence: 99%

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Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

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“…Surgeons may use two anteromedial portals: a high portal close to the patella tendon providing visualization and a second more medial portal just above the meniscus for instrumentation [78]. These independent drilling methods have been shown to produce tunnels with superior function compared with tunnels produced by conventional transtibial drilling methods [78,79].…”

Section: Anatomical Single Bundle Techniquesmentioning

confidence: 99%

Anatomical single bundle anterior cruciate ligament reconstruction

Carmont

Scheffler

Spalding

et al. 2011

Curr Rev Musculoskelet Med

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The Ability of 3 Different Approaches to Restore the Anatomic Anteromedial Bundle Femoral Insertion Site During Anatomic Anterior Cruciate Ligament Reconstruction

Cited by 72 publications

References 22 publications

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Anatomical single bundle anterior cruciate ligament reconstruction

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