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Yahagi Y, Iriuchishima T, Iwama G, Suruga M, Morimoto Y, Nakanishi K. Femoral Tunnel Length in Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction Is Correlated with Body Size and Knee Morphology. J Knee Surg 2024; 37:485-491. [PMID: 37739027 DOI: 10.1055/a-2180-2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
The purpose of this study was to reveal the correlation between anteromedial (AM) and posterolateral (PL) femoral tunnel lengths in anatomical double-bundle anterior cruciate ligament (ACL) reconstruction and body size and knee morphology. Thirty-four subjects undergoing anatomical double-bundle ACL reconstruction were included in this study. Preoperative body size (height, body weight, and body mass index) was measured. Using preoperative magnetic resonance imaging (MRI), quadriceps tendon thickness and the whole anterior-posterior length of the knee were measured. Using postoperative computed tomography (CT), axial and sagittal views of the femoral condyle were evaluated. The correlation between measured intraoperative AM and PL femoral tunnel lengths, and body size and knee morphology using preoperative MRI and postoperative CT parameters was statistically analyzed. Both AM and PL femoral tunnel lengths were significantly correlated with height, body weight, posterior condylar length, and Blumensaat's line length. These results suggest that the femoral ACL tunnel length created using a transportal technique can be estimated preoperatively by measuring the subject's body size and/or the knee morphology using MRI or CT. For clinical relevance, surgeons should be careful to create femoral tunnel of sufficient length when using a transportal technique, especially in knees of subjects with smaller body size and knee morphology. Level of evidence is III.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yusuke Morimoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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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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Plancher KD, Alwine JT, Chan JJ, Petterson SC. The Accessory Medial Portal for Anterior Cruciate Ligament Reconstruction: A Safe Zone to Avoid Neurovascular Complications. Orthop J Sports Med 2020; 8:2325967120952674. [PMID: 33029544 PMCID: PMC7522840 DOI: 10.1177/2325967120952674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023] Open
Abstract
Background: The accessory medial portal (AMP) used for anatomic anterior cruciate ligament reconstruction (ACLR) is gaining popularity. This portal is routinely created at 60° of knee flexion, placing the infrapatellar branch of the saphenous nerve (IBSN) and, less commonly, the descending and superior medial genicular arteries at risk. Purpose/Hypothesis: The purpose of this study was to identify a safe zone for AMP placement in ACLR to minimize the risk of injury to the IBSN. We hypothesized that increased knee flexion angles would decrease the risk to neurovascular structures when creating an AMP. Study Design: Descriptive laboratory study. Methods: A total of 20 cadaveric (10 matched pairs) knees were used for dissection to identify the IBSN and other neurovascular structures. A 30° arthroscope was used to make the central medial portal and AMP at 3 knee flexion angles (60°, 90°, and 110°). Distances were measured from the AMP to branches of the IBSN. Safety of AMP placement was analyzed by assessing the frequency at which spinal needles pierced a neurovascular structure or violated a safe zone. Results: The superior IBSN was significantly closer to the AMP than inferior IBSN. The AMP was significantly farther from the superior IBSN at 110° (8.56 ± 5.28 mm) compared with 60° (5.63 ± 5.00 mm; P = .015) and 90° (6.69 ± 5.03 mm; P = .006). A triangular safe zone was identified at 110° of knee flexion. No neurovascular structures were pierced, and the IBSN was not present in the safe zone. At 90°, the IBSN was not pierced; however, the IBSN did violate the safe zone at 90° of knee flexion. Conclusion: The superior IBSN is at risk for iatrogenic injury with an AMP placed at 60° of knee flexion. The nerve moved distally with knee flexion. While no neurovascular structures were compromised at 90° of knee flexion, the nerve was found to course through the safe zone. A safe zone at 110° of knee flexion decreases the risk of neurovascular injury and makes the AMP safe for ACLR. Clinical Relevance: The AMP at 60° of knee flexion for ACLR poses risk to the IBSN. The IBSN did violate the safe zone at 90° of flexion. We recommend creating an AMP with increased knee flexion to 110° to decrease the risk of iatrogenic injury. When establishing an AMP, one should aim for the center of the defined safe zone, given that the spinal needle used in this study has a smaller diameter than a stab incision.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedics, Albert Einstein College of Medicine, New York, New York, USA.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | | | - Jimmy J Chan
- Orthopaedic Foundation, Stamford, Connecticut, USA
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Lee SS, Seo IW, Cho MS, Shin YS. Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis. PLoS One 2020; 15:e0230497. [PMID: 32203530 PMCID: PMC7089554 DOI: 10.1371/journal.pone.0230497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. Materials and method In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. Results Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10–10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29° (95% CI: 8.07°–22.52°; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69–11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95% CI: 7.24–10.69 mm; P<0.001) studies, whereas different results in terms of femoral tunnel obliquity were noted for the subgroup with cadaveric (10.62°; 95% CI: −6.12° to 27.37°; P = 0.21) and noncadaveric (15.86°; 95% CI: 8.11°–23.60°; P<0.001) studies. Conclusion Anatomic ACL reconstruction resulted in the femoral tunnel length and femoral tunnel obliquity in the coronal plane being shorter and more oblique, respectively, as compared with nonanatomic ACL reconstruction. Level of evidence Therapeutic study, Level III.
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Affiliation(s)
- Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
| | - In-Wook Seo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Min-Soo Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
- * E-mail:
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Nakamura K, Nakamura T, Horie M, Katagiri H, Otabe K, Nakagawa Y, Amemiya M, Sekiya I, Muneta T, Koga H. Anatomic femoral tunnel placement is difficult by the transtibial technique: comparison of three different femoral tunnel drilling techniques in double-bundle anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2020; 28:584-593. [PMID: 31612263 DOI: 10.1007/s00167-019-05740-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/30/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare the position and direction of femoral and tibial tunnels for both the anteromedial bundle (AMB) and posterolateral bundle (PLB) among three different femoral tunnel drilling techniques, transtibial (TT), transportal (TP), and outside-in (OI) techniques, in anatomic double-bundle ACL reconstruction to clarify advantages and disadvantages of each technique. METHODS One-hundred and thirty-nine patients underwent primary ACL reconstruction with an autologous semitendinosus tendon in our institution between 2014 and 2016. Thirteen patients were excluded according to the exclusion criteria. Of the 126 patients, 98 patients agreed to be included in this study. Patients were then randomized into three groups according to the femoral tunnel drilling technique; the TT, TP, and OI groups. Femoral and tibial tunnel angles and positions were measured using three-dimensional computed tomography. RESULTS Of patients who agreed to be included in this study, eight patients (seven in TT and one in OI) were excluded since the femoral tunnel could not be created at the intended position. Eighty-six patients (29 in TT, 29 in TP, and 28 in OI) were included for the analyses. Tunnel angles, as well as tunnel lengths, had significant differences among different techniques depending on each technique's characteristics. In terms of tunnel position, femoral tunnel positions of both the AMB and PLB in the TT group were significantly higher than those in the TP group (AMB: p = 0.003, PLB: p = 0.001), and the PLB tunnel position in the TP group had significantly smaller vaciance than that in the TT group (p = 0.004) and OI group (0.002). CONCLUSIONS The femoral tunnel positions created by the TT technique were significantly higher, with larger variance, than the TP technique in double-bundle ACL reconstruction, although the positions seemed to be within anatomical footprint. In addition, there were several cases in which femoral tunnels could not be created at the intended position by the TT technique. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Kaori Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masafumi Horie
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masaki Amemiya
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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