The proximal posterior cartilage of the lateral femoral condyle can be used as a reference for positioning the femoral tunnel in ACL reconstruction

Abstract

Purpose To describe the femoral insertion of the ACL using the posterior proximal cartilage of the lateral femoral condyle as the anatomical reference. Methods Twenty knees were dissected. The X-axis (deep-shallow) and Y-axis (high-low) were determined using the femoral diaphysis and the proximal cartilage of the lateral femoral condyle (point C) as a reference, which were easily identiied by direct visualization through the anteromedial portal. The distances to the center of the anteromedial and posterolateral bands and to the center of the ACL were measured. ResultsThe mean distances were 7.2 mm (SD: 0.7) between the center of the anteromedial bundle and the Y-axis (AM-Y), 9 mm (SD: 1.1) between the center of the ACL and the Y-axis (M-Y), and 12.7 mm (SD: 0.9) between the center of the posterolateral bundle and the Y-axis (PL-Y). Regarding the distance (from point C to the distal cartilage along the X-axis), the center of the anteromedial bundle (AM) was 35% (SD: 4.9%), the center of the posterolateral bundle was 62% (SD: 3.7%), and the center of the ACL (M) was 44% (SD: 7%) of the CD distance on average. Conclusion Given the similarity among the specimens in terms of the height of the ACL on the Y-axis in relation to the proximal posterior cartilage of the femoral lateral condyle (point C), this point can be used as an arthroscopic intraoperative parameter to deine the position of the femoral tunnel in ACL reconstruction for single-or double-bundle techniques.

App-Based Analysis of Fluoroscopic Images According to Bernard-Hertel Method for the Determination of Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction

“…However, these landmarks are sometimes difficult to define. 6 , 7 , 8 In addition, the arthroscope only provides a 2-dimensional image; therefore, depth relations may be misleading. Usually, industry-supplied aiming devices (so-called offset devices) are used to place a 2.4-mm central pin into the center of the desired location during surgery.…”

Posterior Proximal Cartilage of the Lateral Femoral Condyle as a Reference for Positioning the Femoral Tunnel in ACL Reconstruction

“…Some parameters can be used to help the surgeon determine these points, such as arthroscopic visual parameters (e.g., the lateral femoral intercondylar crest, bifurcated wall, distal joint margin, posterior intercondylar sulcus, and anterior horn of the lateral meniscus) 9 or radiographic parameters, such as the quadrants of Bernard et al 1 Another little-used parameter is the relationship between the posterior proximal cartilage of the lateral femoral condyle and the ACL in both the high low and shallow deep planes. 5 An anatomical study published in 2022 3 concluded that due to the similarity among specimens in the height of the ACL on the shallow deep axis in relation to the proximal posterior cartilage of the lateral femoral condyle (point C), this point can be used as an arthroscopic intraoperative parameter to define the position of the femoral tunnel in ACL reconstruction. Point C can also be used on the high low axis but with greater caution and the additional use of secondary parameters because of the anatomical variation observed between the cases studied.…”

Introducing Skeletally-Mature Anterior Cruciate Ligament Reconstruction Technique Using Reinforcement (SATURN) With Iliotibial Band Autograft

“…Once the intra-articular footprint is identified and the aiming guide is in place, the extra-articular drill sleeve is placed through the drill guide at the predetermined extra-articular footprint location. 14 A guidewire is passed through the guide across the lateral femur to connect the extra-articular (anterolateral ligament) and intra-articular (ACL) femoral footprints, and its position confirmed at both locations. Before tunnel drilling, care is taken to ensure avoidance of injury to the LCL complex at the lateral epicondyle.…”