Tibial attachment area of the anterior cruciate ligament in the extended knee position

Stäubli, H.-U.; Rauschning, Wolfgang

doi:10.1007/bf01467915

Cited by 245 publications

(156 citation statements)

References 46 publications

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“…6). Like the normal ACL [19,25,30] the anterior surface of the graft should graze and be parallel to the slope of the intercondylar roof with the knee in maximum extension [19]. For the graft not to lie anterior to the anterior edge of the normal ACL, the tibial tunnel must be positioned in the posterior half of the normal ACL insertion [19].…”

Section: Five Factors Contributing To Roof Impingementmentioning

confidence: 99%

Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament

Howell

1998

Knee Surgery, Sports Traumatology, Arthroscopy

207

190

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Reconstruction of a form anterior cruciate ligament (ACL) cannot be successful without a properly placed tibial tunnel. Preventable complications such as anterior knee pain, effusions, extension loss, and recurrent instability can occur when the tibial tunnel is improperly placed and the roof and notchplasty are insufficient. This article reviews the principles for anatomic placement of the tibial tunnel so that complications associated with impingement of the ACL graft on the intercondylar roof can be prevented. Five factors that contribute to roof impingement are discussed, including differences in the size and shape of the ACL and the graft, variability in knee extension and roof angle between patients, inability to view the contact between the intercondylar roof and the graft, accentuation of roof impingement from anterior tibial translation caused by quadriceps contraction, and the use of tibial guides that rely on soft-tissue landmarks. A surgical technique is presented which consistently places the tibial tunnel in the pathway of the normal ACL (i.e., anatomic placement) and avoids roof impingement. The indications and need for roof- and wallplasty are discussed.

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Section: Five Factors Contributing To Roof Impingementmentioning

confidence: 99%

Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament

Howell

1998

Knee Surgery, Sports Traumatology, Arthroscopy

207

190

View full text Add to dashboard Cite

show abstract

“…However, the validity and reliability of these measurement techniques have not been established. We measured the location of ACL grafts, using Staubli's technique (Staubli and Rauschning 1994) for the tibia, and a modification of Harner's technique (Harner et al 1994 ) for the femur. We found that the tibial and femoral graft positions as assessed on postoperative radiographs differed significantly from the graft positions measured on intraoperative radiographs.…”

Section: Discussionmentioning

confidence: 99%

Patellar tendon graft position after anterior cruciate ligament reconstruction: Interobserver variability on lateral radiographs

Klos¹,

Harman²,

Devilee³

et al. 1999

Acta Orthopaedica Scandinavica

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“…In accordance with Stä ubli and Rauschning [26] a target value of 43% was assumed and a tolerance of ±4% accepted [27] (Fig. 3).…”

Section: Methodsmentioning

confidence: 99%

Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital

Behrend

Stutz

Keßler

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome. Seventeen surgeons with different levels of experience (between 0 and >150 ACL reconstructions) performed endoscopic ACL repair in uniform technique from August 2000 to August 2003 on 50 patients (18 women, 32 men, age range 18-43 years). The patients were available to clinical and radiological follow-up after an average of 19 months. The clinical outcome was classified according to the International Knee Documentation Committee (IKDC) standard evaluation form. The femoral tunnel was evaluated according to the quadrant method of Bernard and Hertel; the position of the tibial bone tunnel was assessed according to the criteria of Stäubli and Rauschnig. The IKDC score revealed 47 (94%) patients with a normal (A) or nearly normal (B) knee joint at follow-up. According to the quadrant method, the femoral canal was situated on average at 29% in the saggital plane. The tibial tunnel was situated on average at 43% of the a.p. diameter of the tibial condyle. Statistical analysis of our data showed no significant correlation between tunnel placement and surgical expertise. However, a highly significant correlation was found (alpha<0.01) between the femoral position of the tunnel in the sagittal plane and the IKDC score. The more anterior the femoral canal, the poorer the IKDC score. The method of tunnel placement in ACL reconstruction being investigated here only showed slight dependence on surgical experience, whereby good short-term clinical outcomes were achieved. Therefore, the method is suitable for application at a teaching hospital. A far too anterior femoral tunnel placement will probably lead to a decline in the clinical result.

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Tibial attachment area of the anterior cruciate ligament in the extended knee position

Cited by 245 publications

References 46 publications

Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament

Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament

Patellar tendon graft position after anterior cruciate ligament reconstruction: Interobserver variability on lateral radiographs

Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital

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