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Cheng R, Yao G, Dimitriou D, Jiang Z, Yang Y, Tsai TY. The 45° and 60° of sagittal femoral tunnel placement in anterior cruciate ligament reconstruction provide similar knee stability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38973630 DOI: 10.1002/ksa.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE The aim of the present study was to compare 45° and 60° of sagittal femoral tunnel angles in terms of anterior tibial translation (ATT), valgus angle and graft in situ force following anterior cruciate ligament reconstruction (ACLR). METHODS Ten porcine knees were subjected to the following loading conditions: (1) 89 N anterior tibial load at 35° (full extension), 60° and 90° of knee flexion and (2) 5 N m valgus tibial moment at 35° and 45° of knee flexion. ATT and graft in situ force of the intact anterior cruciate ligament (ACL) and ACLR were collected using a robotic universal force/moment sensor (UFS) testing system for (1) ACL intact, (2) ACL-deficient (ACLD) and (3) two different ACLR using different sagittal femoral tunnel angles (coronal 45°/sagittal 45° and coronal 45°/sagittal 60°). RESULTS During the anterior tibial load, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly higher ATT than that of the ACL-intact knees at 60° of knee flexion (p < 0.05). The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 60° had significantly lower graft in situ force than that of the ACL-intact knees at 60° and 90° of knee flexion (p < 0.05). During the valgus tibial moment, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly lower graft in situ force than that of the ACL-intact knees at all knee flexions (p < 0.05). CONCLUSIONS The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° provided similar ATT, valgus angle and graft in situ force to that of ACLR knees at coronal 45°/sagittal 60°. Therefore, both femoral tunnel angles could be used in ACLR, as the sagittal femoral tunnel angle does not appear to be relevant in post-operative knee stability. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Gai Yao
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
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[Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded "tibial tendon bolt" fixation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:420-424. [PMID: 35426280 PMCID: PMC9011068 DOI: 10.7507/1002-1892.202111076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament (PCL) with embedded "tibial tendon bolt" fixation. METHODS The clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded "tibial tendon bolt" fixation through the tibial "8"-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years (mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and (+) Ⅲ degree in posterior drawer test; McMurry test (+) in 13 cases, valgus stress test (+) in 8 cases, Lachman test (+) in 9 cases, and Dial test (+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee (IKDC) score was 18.0±15.2, and the detection value of KT-1000 was (14.34±2.73) mm. The time from injury to operation was 8-225 days, with a median of 11 days. RESULTS All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all (-). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones (t=-38.400, P<0.001; t=-27.190, P<0.001). The results of posterior drawer test were (-) in 21 cases, (+) Ⅰ degree in 9 cases, and (+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were (5.56±2.28) mm and (5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values (P<0.05). CONCLUSION The application of arthroscopic reconstruction of PCL using embedded "tibial tendon bolt" fixation through the tibial "8"-shaped tunnel is an effective, simple, and safe surgical procedure.
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黄 碧, 邓 文, 李 韬, 李 棋. [Progress of different methods for femoral tunnel positioning in anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:118-123. [PMID: 33448209 PMCID: PMC8171607 DOI: 10.7507/1002-1892.202005003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/31/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To systematically review the progress of different methods for femoral tunnel positioning in anterior cruciate ligament (ACL) reconstruction and provide a clinical reference for treatment of ACL rupture. METHODS The literature about the femoral tunnel positioning in ACL reconstruction was widely reviewed. The advantages and disadvantages and the clinical results of each method were summarized. RESULTS Currently in ACL reconstruction, methods for femoral tunnel positioning include transtibial technique (TT), anteromedial technique (AM), outside-in (OI), modified TT (mTT), and computer assisted surgery. There is no significant difference in the postoperative effectiveness between TT technique and AM technique. Compared with the TT technique, the OI technique has higher rotational stability of knee, but there is no significant difference in clinical results. The femoral tunnel located by mTT technique is closer to the anatomical placement than that of TT technique, but mTT technique is not effective for systematically anatomic femoral tunnel positioning, and further research is needed to prove its advantages. CONCLUSION Different femoral tunnel positioning methods have their own advantages and disadvantages, and there is no definite evidence that one is superior than the rest.
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Affiliation(s)
- 碧滢 黄
- 四川大学华西临床医学院(成都 610041)West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 文宇 邓
- 四川大学华西临床医学院(成都 610041)West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 韬 李
- 四川大学华西临床医学院(成都 610041)West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 棋 李
- 四川大学华西临床医学院(成都 610041)West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Wang JH, Lee DK, Chung ST, Lee BH. Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique. BMC Musculoskelet Disord 2017; 18:237. [PMID: 28569166 PMCID: PMC5452363 DOI: 10.1186/s12891-017-1599-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Commercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide. METHODS A total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed. RESULTS In the AM tunnel, tunnel axis angles in the coronal (β = 0.0252, p = 0.022) and sagittal (β = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (β = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700). CONCLUSION Drilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.
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Affiliation(s)
- Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - Sung Taek Chung
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea.
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Niki Y, Nagai K, Harato K, Suda Y, Nakamura M, Matsumoto M. Effects of femoral bone tunnel characteristics on graft-bending angle in double-bundle anterior cruciate ligament reconstruction: a comparison of the outside-in and transportal techniques. Knee Surg Sports Traumatol Arthrosc 2017; 25:1191-1198. [PMID: 26294057 DOI: 10.1007/s00167-015-3761-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/11/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Bone tunnel creation techniques influence the 3-dimensional (3D) position of bone tunnels and graft-bending angle in anterior cruciate ligament (ACL) reconstruction. This study assessed graft-bending angle and 3D characteristics of femoral bone tunnels and compared them between outside-in (OI) and transportal (TP) techniques. METHODS Participants comprised 64 patients who underwent anatomic double-bundle ACL reconstruction, allocated to OI and TP groups (n = 32 each). The graft orientation plane exhibiting the largest graft-bending angle at the femoral tunnel aperture with the knee in extension was reconstructed from CT data using 3D imaging software. In this plane, graft-bending angle was compared between the OI and TP techniques. RESULTS Although positionings of the intra-articular apertures of the femoral and tibial bone tunnels were similar, several spatial parameters of bone tunnels differed between techniques. Graft-bending angles of both anteromedial and posterolateral bundles were significantly more acute with the OI technique than with the TP technique. On coronal-plane CT, angle of the bone tunnel axis relative to the distal condylar axis correlated negatively with graft-bending angle, while in the axial plane, angle of the bone tunnel axis relative to the posterior condylar axis correlated positively with graft-bending angle. Lysholm score, pivot shift test, and anteroposterior laxity at >2.5-year follow-up demonstrated no significant differences between techniques. DISCUSSION Different bone tunnel directions in OI and TP techniques substantially affected graft-bending angle , despite similar positionings of the intra-articular apertures. Graft-bending angle with the OI technique was acute, but risk of posterior blowout of the lateral femoral condyle was decreased. Surgeons should create the femoral tunnel while considering an obtuse graft-bending angle without increasing the risk of posterior blowout. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Katsuya Nagai
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Suda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Park SH, Moon SW, Lee BH, Park S, Kim Y, Lee D, Lim S, Wang JH. Arthroscopically blind anatomical anterior cruciate ligament reconstruction using only navigation guidance: a cadaveric study. Knee 2016; 23:813-9. [PMID: 27407011 DOI: 10.1016/j.knee.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To develop a preoperative planning and navigation system for anatomic anterior cruciate ligament (ACL) reconstruction and to evaluate the accuracy and the efficacy of anatomical ACL reconstruction using only navigation guidance. METHODS A three-dimensional (3D) preoperative planning and navigation system was developed from open source libraries. Twenty knees from 10 fresh-frozen human cadavers underwent navigation-only guided double-bundle ACL reconstruction using the transportal technique. A computed tomography (CT) scan was performed after ACL reconstruction to create a 3D surface model of the distal femur. We evaluated the tunnel position by Bernard's quadrant method, the tunnel orientation by measuring the tunnel angle in three projected planes, and the incidence of posterior cortical damage. Then, we compared preoperative planning with the postoperative results. RESULTS The difference in tunnel position between preoperative planning and the postoperative results was a mean of 2.50±1.75mm (range, 0.77 to 5.85mm) in the anteromedial (AM) tunnel and a mean of 3.53±2.20mm (range, 0.39 to 7.92mm) in the posterolateral (PL) tunnel. The difference in tunnel orientation was a mean of 6.74±6.70° (range, 0.35 to 25.6°) in the AM tunnel and a mean of 5.73±3.51° (range, 1.58 to 15.04°) in the PL tunnel. No statically significant difference was observed. Posterior cortical damage developed in seven cases (35%). CONCLUSIONS Our navigation-only guided ACL reconstruction produced consistent femoral tunnel position and orientation results. The accuracy and consistency of femoral tunneling were improved by using the preoperative planning and navigation system.
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Affiliation(s)
- Sin Hyung Park
- Department of Orthopaedic Surgery, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Gyeonggi-do, South Korea
| | - Sang Won Moon
- Department of Orthopaedic Surgery, Inje University School of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Hallym University School of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Sehyung Park
- Center for Bionics, Korea Institute Science and Technology, Seoul, South Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute Science and Technology, Seoul, South Korea
| | - Deukhee Lee
- Center for Bionics, Korea Institute Science and Technology, Seoul, South Korea
| | - Sunghwan Lim
- Center for Bionics, Korea Institute Science and Technology, Seoul, South Korea
| | - Joon Ho Wang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro Gangnam-Gu, Seoul, South Korea.
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Zhang Y, Xu C, Dong S, Shen P, Su W, Zhao J. Systemic Review of Anatomic Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction: Does Femoral Tunnel Drilling Technique Matter? Arthroscopy 2016; 32:1887-904. [PMID: 27184099 DOI: 10.1016/j.arthro.2016.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide an up-to-date assessment of the difference between anatomic double-bundle anterior cruciate ligament (ACL) reconstruction (DB-ACLR) and anatomic single-bundle ACL reconstruction (SB-ACLR). We hypothesized that anatomic SB-ACLR using independent femoral drilling technique would be able to achieve kinematic stability as with anatomic DB-ACLR. METHODS A comprehensive Internet search was performed to identify all therapeutic trials of anatomic DB-ACLR versus anatomic SB-ACLR. Only clinical studies of Level I and II evidence were included. The comparative outcomes were instrument-measured anterior laxity, Lachman test, pivot shift, clinical outcomes including objective/subjective International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale and complication rates of extension/flexion deficits, graft failure, and early osteoarthritis. Subgroup analyses were performed for femoral tunnel drilling techniques including independent drilling and transtibial (TT) drilling. RESULTS Twenty-two clinical trials of 2,261 anatomically ACL-reconstructed patients were included in the meta-analysis. Via TT drilling technique, anatomic DB-ACLR led to improved instrument-measured anterior laxity with a standard mean difference (SMD) of -0.42 (95% confidence interval [CI] = -0.81 to -0.02), less rotational instability measured by pivot shift (SMD = 2.76, 95% CI = 1.24 to 6.16), and higher objective IKDC score with odds ratio (OR) of 2.28 (95% CI = 1.19 to 4.36). Via independent drilling technique, anatomic DB-ACLR yielded better pivot shift (SMD = 2.04, 95% CI = 1.36 to 3.05). Anatomic DB-ACLR also revealed statistical significance in subjective IKDC score compared with anatomic SB-ACLR (SMD = 0.27, 95% CI = 0.05 to 0.49). CONCLUSIONS Anatomic DB-ACLR showed better anterior and rotational stability and higher objective IKDC score than anatomic SB-ACLR via TT drilling technique. Via independent drilling technique, however, anatomic DB-ACLR only showed superiority of rotational stability. All clinical function outcomes except subjective IKDC score were not significantly different between anatomic DB-ACLR and SB-ACLR. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Yang Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiqui Dong
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peng Shen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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