Doppelbündel- vs. Einzelbündelrekonstruktion

Evaluating the tibial and femoral insertion site of the anterior cruciate ligament using an objective coordinate system: a cadaver study

PURPOSE

The purpose of this study was to evaluate the tibial and femoral insertion site of the anterior cruciate ligament (ACL) using an objective coordinate system in a cadaver study in order to confirm radiological assumptions of previous investigators who identified the tibial footprint (T) of the ACL on T (5.3; 5.5) and the femoral footprint (F) on F (2.9; 3.5).

METHODS

The tibial and femoral insertion site of the ACL was analysed on 30 human cadaver knee joints preserved according to the technique by Thiel. Thirty femora and tibiae were photographed under standardised methods and measured on a coordinate system twice by two examiners with respect to the ACL's footprint. We evaluated these measurements by use of the Cohen's kappa inter- and intraobserver coefficient for two observers.

RESULTS

The photographs and tibial and femoral measurements were achieved with an almost perfect and a substantial agreement of inter- and intraobserver coefficients. Further, we could demonstrate that assumptions of anatomic points in previous radiological investigations were correct.

CONCLUSIONS

Our findings confirmed the anatomic tibial and femoral ACL footprint of a previous investigation and further the reproducibility of our coordinate system as an objective method for graft placement evaluation.

Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction

PURPOSE

The purpose of this study was to correlate anatomic and nonanatomic tibial and femoral tunnel positions after anterior cruciate ligament (ACL) reconstruction with clinical outcome by use of bone-patellar tendon-bone (BPTB) single-bundle (SB) and semitendinosus-gracilis (STG) double-bundle (DB) techniques.

METHODS

The 3-dimensional computed tomography scans of 53 patients' knees (27 BPTB-SB and 26 STG-DB) were prepared and measured by 2 examiners according to their tibial and femoral tunnel positions. We evaluated these radiologic constructions and measurements by use of the Cohen κ interobserver and intraobserver coefficient for 2 observers. Patients undergoing both techniques were divided into anatomic and nonanatomic reconstructions according to the findings of Zantop and Petersen. We correlated anatomically and nonanatomically reconstructed patients with clinical outcome by the Tegner score, Western Ontario and McMaster Universities Osteoarthritis Index score, International Knee Documentation Committee score, KT-1000 arthrometer (MEDmetric, San Diego, CA), and pivot-shift test in both techniques.

RESULTS

The radiologic constructions and measurements of 53 computed tomography scans were achieved with a good agreement of interobserver and intraobserver coefficients for 2 observers. We found significantly superior clinical outcome in anatomic ACL reconstructions in both techniques in terms of higher clinical scores (Tegner and International Knee Documentation Committee), higher anterior posterior stability, and less pivot shift. We observed the best outcome in anatomic STG-DB reconstructions.

CONCLUSIONS

This investigation showed that better clinical results are associated with anatomic ACL reconstructions.

LEVEL OF EVIDENCE

Level II, prospective comparative study.

[Rupture of the anterior cruciate ligament. Diagnostics and therapy]

Rupture of the anterior cruciate ligament (ACL) is the most common ligamentous knee injury. The knee is stabilized by the cruciate ligaments and the collateral ligaments. The ACL originates from the inner surface of the lateral condyle of the femur, runs in an anterior medial direction and inserts at the tibial plateau in the intercondyle area. The most common injury is an indirect knee trauma, typically a joint torsion in sports. Patients often describe a snapping noise followed by hemarthrosis. Concomitant injuries are lesions of the medial collateral ligament, the medial meniscus (unhappy triad) and chondral fractures. The age peak is between 15 and 30 years with a higher incidence in females. The cardinal symptom of the ACL rupture is the giving way phenomenon. The clinical diagnosis is provided by a positive Lachman test, a positive pivot shift test and the anterior drawer test. Fractures can be excluded by X-ray examination. Magnetic resonance imaging (MRI) allows the evaluation of the internal knee structures. ACL repair is carried out by arthroscopically assisted bone-tendon-bone or semitendinosus grafting techniques. Early rehabilitation is important for a good functional outcome.