Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan

Abstract

This study compares the positioning of femoral AM and PL tunnels obtained with specific ancillary instruments during anatomic double-bundle ACL reconstruction with the native ACL footprint using three-dimensional computed tomography (3-D CT). In 35 consecutive patients, anatomic double-bundle ACL reconstruction was performed with specific ancillary instruments. Three-dimensional CT reconstruction of both knees was performed using the volume rendering technique. In the controls (contralateral knee, with intact ACL), the angle between the longitudinal axis of the footprint and the axis of the femur, the "footprint angle" (FA) was measured. On the involved side, using the axis passing through the tunnel centers, FA was also measured. In both the groups, footprint's length and width, and distances to cartilage margins were measured. FA was 28.1 degrees +/- 5.0 degrees in the controls and 32.9 degrees +/- 15.8 degrees on the involved side (n.s.). There was no statistical difference between the two groups for the other morphometric parameters: footprint's length and width, and distances to cartilage margins. Using specific ancillary instruments the morphometric parameters of the reconstructed femoral ACL footprint were similar to the native ACL.

Contemporary Anterior Cruciate Ligament Reconstruction

“…11) between them in order to insure independent fixation of each bundle Christel et al, 2005;Christel et al, 2008 a-c). Three-dimensional CT studies (Fig 12 A) have validated the accuracy of the instruments (Basdekis et al, 2009a). The resulting cortical bone bridge separating the tunnel apertures remains stable with time (Hantes et al, 2010).…”

“…Unfortunately most of the publications related to double-bundle ACL reconstruction outcome do not document the position of the tunnels. In order to document tunnel position after surgery, 3-dimensional CT scan is the method of choice (Basdekis et al, 2009a;Forsythe B et al, 2010;Saharsrabudhe et al, 2010). Accordingly, if many publications relate to double-bundle ACL reconstruction, it is hard to distinguish between those which perform anatomical reconstruction, i.e.…”

Nuclear Medicine Imaging of Knee Injuries

“…In addition, the evaluation of the tunnel position as well as the assessment of tunnel widening is preferably performed on CT. Numerous authors have emphasized the benefi ts of 3D-CT for the assessment of tunnel position after ACL reconstruction (Basdekis et al 2009 ;Hirschmann et al 2012a ;Purnell et al 2008 ).…”

Radiological evaluation for conflict of the femoral tunnel entrance area prior to anterior cruciate ligament revision surgery

“…The use of 3D-CT or MRI reconstruction has been reported occasionally for the visualisation of the native and the reconstructed femoral insertion on the femur [11,[23][24][25][26][27][28][29][30][31], and in patients with failed reconstruction [32,33]. This radiological tool has been validated and shown to be feasible [25].…”