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Chung K, Choi CH, Kim SH, Kim SJ, Choi HC, Jung M. Influence of knee flexion angle on graft bending angle during anterior cruciate ligament reconstruction using the transportal technique. Sci Rep 2023; 13:13638. [PMID: 37608212 PMCID: PMC10444777 DOI: 10.1038/s41598-023-41002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 08/20/2023] [Indexed: 08/24/2023] Open
Abstract
This study aimed to examine change in the graft bending angle (GBA) according to various knee flexion angles in creating femoral tunnel by the transportal technique in ACL reconstruction, and to reveal knee flexion angle minimizing GBA while maintaining stable femoral tunnel characteristics. Patients who underwent ACL reconstruction using the transportal technique between January 2017 and December 2018 were retrospectively reviewed. Patients were classified into three groups according to knee flexion angle when creating femoral tunnel (group 1: < 120° (n = 19); group 2: 120-129° (n = 32); group 3: ≥ 130° (n = 33). GBA was measured on three-dimensional knee model reconstructed from postoperative computed tomography images. The length of the femoral tunnel and posterior wall blow-out were also checked. There was significant difference of GBA between the groups (group 1 = 112.1°; group 2 = 106.4°; group 3 = 101.4°, p < 0.001). The knee flexion angle in creating femoral tunnel was negatively correlated with GBA (r = - 0.733, p < 0.001). Five patients in group 1 had short femoral tunnel. GBA was influenced by knee flexion angle in creating femoral tunnel and got more acute as the knee flexion angle increased. Considering length and risk of wall blow-out in femoral tunnel, and GBA, knee flexion angle between 120 and 130° could be recommended as appropriate angle to create optimal femoral tunnel in ACL reconstruction using the transportal technique.
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Affiliation(s)
- Kwangho Chung
- The Department of Orthopaedic Surgery, The Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Republic of Korea
| | - Chong Hyuk Choi
- The Department of Orthopaedic Surgery, The Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Republic of Korea
| | - Sung-Hwan Kim
- The Department of Orthopaedic Surgery, The Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Republic of Korea
| | - Sung-Jae Kim
- The Department of Orthopaedic Surgery, The Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Republic of Korea
| | - Hee Chan Choi
- The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- The Department of Orthopaedic Surgery, The Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Republic of Korea.
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Zhang X, Qian Y, Gao F, He C, Guo S, Gao Q, Zhou J. High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid-term follow-up after anatomic anterior cruciate ligament reconstruction. PeerJ 2023; 11:e15898. [PMID: 37609439 PMCID: PMC10441525 DOI: 10.7717/peerj.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background The position of the femoral insertion has a great influence on the laxity of the knee joint after ACLR, especially for rotational laxity. Purpose To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed. Results After 5 years postoperatively, the SSD in the anteroposterior knee laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05). Conclusion Patients in HAM group showed better control over anteroposterior laxity, rotational laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.
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Affiliation(s)
- Xiaohan Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yi Qian
- National Institute of Sports Medicine, Beijing, China
| | - Feng Gao
- National Institute of Sports Medicine, Beijing, China
| | - Chen He
- National Institute of Sports Medicine, Beijing, China
| | - Sen Guo
- National Institute of Sports Medicine, Beijing, China
| | - Qi Gao
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jingbin Zhou
- National Institute of Sports Medicine, Beijing, China
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Dimitriou D, Cheng R, Yang Y, Helmy N, Tsai TY. Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model. Orthop J Sports Med 2022; 10:23259671221096417. [PMID: 35651481 PMCID: PMC9149612 DOI: 10.1177/23259671221096417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement
through the anteromedial (AM) portal technique requires more horizontal
drilling of the femoral tunnel as compared with the transtibial (TT)
technique, which may lead to a shorter femoral tunnel and affect
graft-to-bone healing. The effect of coronal and sagittal femoral tunnel
obliquity angle on femoral tunnel length has not been investigated. Purpose: To compare the length of the femoral tunnels created with the TT technique
versus the AM portal technique at different coronal and sagittal obliquity
angles using the native femoral ACL center as the starting point of the
femoral tunnel. The authors also assessed sex-based differences in tunnel
lengths. Study Design: Descriptive laboratory study. Methods: Magnetic resonance imaging scans of 95 knees with an ACL rupture (55 men, 40
women; mean age, 26 years [range, 16-45 years]) were used to create
3-dimensional models of the femur. The femoral tunnel was simulated on each
model using the TT and AM portal techniques; for the latter, several coronal
and sagittal obliquity angles were simulated (coronal, 30°, 45°, and 60°;
sagittal, 45° and 60°), representing the 10:00, 10:30, and 11:00 clockface
positions for the right knee. The length of the femoral tunnel was compared
between the techniques and between male and female patients. Results: The mean ± SD femoral tunnel length with the TT technique was 40.0 ± 6.8 mm.
A significantly shorter tunnel was created with the AM portal technique at
30° coronal/45° sagittal (35.5 ± 3.8 mm), whereas a longer tunnel was
created at 60° coronal/60° sagittal (53.3 ± 5.3 mm; P <
.05 for both). The femoral tunnel created with the AM portal technique at
45° coronal/45° sagittal (40.7 ± 4.8 mm) created a similar tunnel length as
the TT technique. For all techniques, the femoral tunnel was significantly
shorter in female patients than male patients. Conclusion: The coronal and sagittal obliquity angles of the femoral tunnel in ACL
reconstruction can significantly affect its length. The femoral tunnel
created with the AM portal technique at 45° coronal/45° sagittal was similar
to that created with the TT technique. Clinical Relevance: Surgeons should be aware of the femoral tunnel shortening with lower coronal
obliquity angles, especially in female patients.
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Affiliation(s)
- Dimitris Dimitriou
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Rongshan Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naeder Helmy
- Department of Orthopedics, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Haroun HK, Abouelsoud MM, Allam MR, Abdelwahab MM. Transtibial versus independent femoral tunnel drilling techniques for anterior cruciate ligament reconstruction: evaluation of femoral aperture positioning. J Orthop Surg Res 2022; 17:166. [PMID: 35303903 PMCID: PMC8931956 DOI: 10.1186/s13018-022-03040-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Femoral tunnel can be drilled through tibial tunnel (TT), or independent of it (TI) by out-in (OI) technique or by anteromedial (AM) technique. No consensus has been reached on which technique achieves more proper femoral aperture position because there have been evolving concepts in the ideal place for femoral aperture placement. This meta-analysis was performed to analyze the current literature comparing femoral aperture placement by TI versus TT techniques in ACL reconstruction. Methods We performed a comprehensive systematic review and meta-analysis of English-language literature in PubMed, Cochrane, and Web of Science databases for articles comparing femoral aperture placement by TI versus TT techniques with aperture position assessed by direct measurement or by postoperative imaging, PXR and/or CT and/or MRI. Results We included 55 articles with study population of 2401 knees of whom 1252 underwent TI and 1149 underwent TT techniques. The relevant baseline characteristics, whenever compared, were comparable between both groups. There was nonsignificant difference between TI and TT techniques in the distance from aperture center to footprint center and both techniques were unable to accurately recreate the anatomic footprint position. TI technique significantly placed aperture at more posterior position than TT technique. TI technique significantly lowered position of placed aperture perpendicular to Blumensaat’s line (BL) than TT technique, and modifications to TT technique had significant effect on this intervention effect. Regarding sagittal plane aperture placement along both AP anatomical axis and BL, there was nonsignificant difference between both techniques. Conclusion Modifications to TT technique could overcome limitations in aperture placement perpendicular to BL. The more anterior placement of femoral aperture by TT technique might be considered, to some extent, a proper position according to recent concept of functional anatomical ACL reconstruction. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03040-5.
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Affiliation(s)
- Haitham K Haroun
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Al-Abbasya District, Cairo, Egypt.
| | - Maged M Abouelsoud
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Al-Abbasya District, Cairo, Egypt
| | | | - Mahmoud M Abdelwahab
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Al-Abbasya District, Cairo, Egypt
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The Graft Insertion Length in the Femoral Tunnel During Anterior Cruciate Ligament Reconstruction With Suspensory Fixation and Tibialis Anterior Allograft Does Not Affect Surgical Outcomes but Is Negatively Correlated With Tunnel Widening. Arthroscopy 2021; 37:2903-2914.e1. [PMID: 33887417 DOI: 10.1016/j.arthro.2021.03.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the surgical outcomes of anterior cruciate ligament (ACL) reconstruction using a low-dose irradiated tibialis anterior allograft with a fixed-loop cortical suspension device for the femur based on the graft insertion length (GIL) in the femoral tunnel. METHODS Between January 2010 and January 2018, the medical records of consecutive patients who underwent arthroscopic ACL reconstruction with a tibialis anterior allograft fixed with the EndoButton CL for the femur and who had at least 2 years of follow-up were retrospectively evaluated. Patients were classified into 3 groups based on the GIL in the femoral tunnel (group 1, GIL < 15 mm; group 2, GIL of 15-20 mm; and group 3, GIL > 20 mm), and their functional scores, knee laxity, and radiographic parameters were evaluated. RESULTS A total of 91 patients were analyzed. There were no statistically significant differences in the functional scores and knee laxity between the 3 groups at 2 years postoperatively. However, significant differences were observed in tunnel widening at 1 year postoperatively in the femur (P = .045 for absolute value and P = .004 for relative value) and the tibia (P = .014 for absolute value and P = .012 for relative value), revealing that both the femoral and tibial tunnels widened as the GIL decreased. Additional linear regression analyses were performed to identify whether the GIL independently affects tunnel widening. Consequently, the femoral tunnel depth, tunnel diameter, and GIL were found to independently influence femoral tunnel widening (P = .008, P = .019, and P < .001, respectively), whereas the tunnel diameter and GIL affected tibial tunnel widening (P < .001 and P = .004, respectively). CONCLUSIONS The GIL in the femoral tunnel during ACL reconstruction using a tibialis anterior allograft with a fixed-loop cortical suspension device for the femur has no significant association with the postoperative functional outcomes and knee laxity, but it has a negative correlation with tunnel widening in the femur and the tibia. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Peres LR, Teixeira MS, Scalizi Júnior C, Akl Filho W. Answer to the Letter to the Editor Regarding the Comments on the Article "Radiological Evaluation of the Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction". Rev Bras Ortop 2021; 56:127. [PMID: 33627914 PMCID: PMC7895614 DOI: 10.1055/s-0040-1722595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Luciano Rodrigo Peres
- Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | - Matheus Silva Teixeira
- Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | - Caetano Scalizi Júnior
- Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
| | - Wolf Akl Filho
- Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
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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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Peres LR, Teixeira MS, Scalizi Júnior C, Akl Filho W. Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction. Rev Bras Ortop 2018; 53:397-403. [PMID: 30027069 PMCID: PMC6051960 DOI: 10.1016/j.rboe.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/28/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To evaluate the inclination and the length of the femoral tunnel in patients submitted to anterior cruciate ligament reconstruction (ACL) surgery by transtibial and anatomical techniques. METHODS This is an analytical observational study in patients with ACL injury that underwent arthroscopic reconstruction through transtibial and anatomical surgical techniques. In the immediate postoperative period, computed tomography (CT) and anteroposterior (AP) view digital radiographs (X-rays) were performed to evaluate the inclination and length of the femoral tunnel. RESULTS Forty-two patients were analyzed: 27 underwent anatomical reconstruction and 15, transtibial reconstruction. The inclination angle and tunnel length by the transtibial technique are always greater than by the anatomical technique. The mean inclination angles were 59.75° (53.9-66.1°) in the X-rays and 54.17° (43.5-62.3°) in CT for the transtibial technique, and 42.91° (29.3-57.4°) in the X-rays and 39.10° (23.8-50.6°) in CT for the anatomical technique. Regarding the length of the femoral tunnel, the transtibial technique promotes longer tunnels: mean 55.7 mm (40.0-70.2 mm) in the transtibial and 35.5 mm (24.5-47 mm) in the anatomical technique. No statistically significant correlation was observed between the length and the inclination of the tunnel, regardless of the technique used. Thus, these variables can be considered as independent. CONCLUSION The anatomical reconstruction technique presented shorter femoral tunnels and lower angle of inclination than the transtibial technique. The CT showed smaller inclination angle than the X-rays, regardless of the surgical technique.
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Affiliation(s)
| | - Matheus Silva Teixeira
- Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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Peres LR, Teixeira MS, Júnior CS, Filho WA. Avaliação radiológica do posicionamento do túnel femoral na reconstrução do ligamento cruzado anterior. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cunningham G, Martineau PA, Gohil S. The drill wobble effect: oversizing the femoral tunnel during ACL reconstruction. PHYSICIAN SPORTSMED 2018; 46:44-47. [PMID: 29172919 DOI: 10.1080/00913847.2018.1410426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In ACL reconstruction, autologous tendon graft can be attached to the femur, within a boney tunnel, using an Endobutton device. The ultimate aim being to achieve biological fixation and incorporation into the bone. Accurate bone tunnel diameter to match the tendon graft is vital to biologic incorporation and strength. The common technique of in sequence passing a guide wire, a cannulated 4.5 mm Endobutton drill, then a cannulated femoral socket drill causes the guidewire to lose cortical fixation and stability before the femoral socket drill is passed. The Objective of this study is to analyze this common technique of femoral socket creation and determine if it results in unintentionally oversizing the femoral socket due to femoral socket drill-wobble over a destabilised guide wire. METHODS 12 cadaveric femoral pairs equally divided between two groups underwent femoral socket creation in one of the two following sequences. Group 1: Guidewire, 4.5 mm endobutton drill, 8 mm femoral socket drill. Group 2: Guidewire, 8 mm femoral socket drill, 4.5 mm endobutton drill. The created femoral tunnels apertures and calibres were measured and then compared for accuracy between the two groups. RESULTS Passing the 4.5 mm drill before the 8 mm socket drill results in oversized tunnel apertures and calibres when compared to passing an 8 mm socket drill after the 4.5 mm drill has been passed (p<0.0001). CONCLUSION To most precisely create an 8 mm femoral socket in ACL reconstruction, the 8 mm femoral socket reamer followed by the 4.5 mm should be passed over the guide wire to prevent guide wire destabilization and drill-wobble.
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Affiliation(s)
| | - Paul A Martineau
- b Division of Orthopaedic Surgery , McGill University Health Centre , Montreal , Canada
| | - Satyen Gohil
- a Orthopaedic Surgery , Fiona Stanley Hospital , Murdoch , Australia
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Hiramatsu K, Mae T, Tachibana Y, Nakagawa S, Shino K. Contact area between femoral tunnel and interference screw in anatomic rectangular tunnel ACL reconstruction: a comparison of outside-in and trans-portal inside-out techniques. Knee Surg Sports Traumatol Arthrosc 2018; 26:519-525. [PMID: 29058021 DOI: 10.1007/s00167-017-4732-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to compare the femoral tunnel length, the femoral graft bending angle at the femoral tunnel aperture, and the contact area between the femoral tunnel wall and an interference screw used for fixation in anatomic rectangular tunnel anterior cruciate ligament (ACL) reconstruction (ART ACLR). METHODS The study included 149 patients with primary ACL injury who underwent ART ACLR. Preoperatively, flexion angle of the index knee was checked under general anaesthesia. Those of less than 130° of passive flexion were assigned to the outside-in (OI) technique (78 patients), while the others to the trans-portal inside-out (TP) technique (71 patients). The patients underwent computed tomography with multiplanar reconstruction at 3-5 weeks post-operatively. Femoral tunnel length, graft bending angle, and contact ratio between the IFS and femoral tunnel were assessed. P < 0.05 was considered statistically significant. RESULTS The femoral tunnel length in the OI technique was significantly longer than that in the TP technique (P < 0.001). The femoral graft bending angle in the OI technique was significantly more acute than that in the TP technique (P < 0.001). The contact ratio in the OI technique was significantly larger than that in the TP technique at every point in the femoral tunnel (P < 0.001). CONCLUSIONS The OI technique resulted in a more acute femoral graft bending angle, longer mean femoral tunnel length, and larger contact ratio than the TP technique after ART ACLR. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Shigeto Nakagawa
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
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Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size. Knee Surg Sports Traumatol Arthrosc 2017; 25:1576-1582. [PMID: 27541734 DOI: 10.1007/s00167-016-4295-7] [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: 04/24/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the distribution of different sizes of the area of the tibial insertion site among the population and to evaluate whether preoperative MRI measurements correlate with intraoperative findings to enable preoperative planning of the required graft size to cover the tibial insertion site sufficiently. The hypothesis was that the area of the tibial insertion site varies among individuals and that there is good agreement between MRI and intraoperative measurements. METHODS Intraoperative measurements of the tibial insertion site were taken on 117 patients. Three measurements were taken in each plane building a grid to cover the tibial insertion site as closely as possible. The mean of the three measurements in each plane was used for determination of the area. Two orthopaedic surgeons, who were blinded to the intraoperative measurements, took magnetic resonance imaging (MRI) measurements of the area of the tibial insertion site at two different time points. RESULTS The intraoperative measured mean area was 123.8 ± 21.5 mm2. The mean area was 132.8 ± 15.7 mm2 (rater 1) and 136.7 ± 15.4 mm2 (rater 2) when determined using MRI. The size of the area was approximately normally distributed. Inter-rater (0.89; 95 % CI 0.84, 0.92; p < 0.001) and intrarater reliability (rater 1: 0.97; 95 % CI 0.95, 0.98; p < 0.001; rater 2: 0.95; 95 % CI 0.92, 0.96; p < 0.001) demonstrated excellent test-retest reliability. There was good agreement between MRI and intraoperative measurement of tibial insertion site area (ICCs rater 1: 0.80; 95 % CI 0.71, 0.87; p < 0.001; rater 2: 0.87; 95 % CI 0.81, 0.91; p < 0.001). CONCLUSION The tibial insertion site varies in size and shape. Preoperative determination of the area using MRI is repeatable and enables planning of graft choice and size to optimally cover the tibial insertion site. LEVEL OF EVIDENCE III.
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Alnusif N, Hart A, Baroudi M, Marien R, Burman M, Martineau PA. Drill wobble - effect on femoral tunnel aperture during anterior cruciate ligament reconstruction. J Exp Orthop 2016; 3:37. [PMID: 27957713 PMCID: PMC5153388 DOI: 10.1186/s40634-016-0073-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/03/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In anterior cruciate ligament reconstruction performed using cortical button fixation on the femur, we have observed a "wobble" effect that can occur when a cannulated femoral drill is used over a guide pin that is not securely fixed in bone. Our study assessed the effect of drill "wobble" on femoral tunnel aperture in sawbones. METHODS Femoral tunnels were drilled in sawbones, which had been divided in two groups of 10 each, per drilling technique. The "wobble" technique group had the smaller cortical button drill passed before drilling the graft socket with the bigger diameter femoral drill. In contrast, in the "non-wobble" technique group, the smaller cortical button drill was passed after drilling the graft socket. The aperture dimensions: antero-posterior, proximo-distal and oblique, as well as the length of each tunnel, were measured. RESULTS While the average dimensions of the tunnels were similar between the two techniques, there was significantly more variation in the antero-posterior measurements for the wobble technique as compared to the non-wobble technique (mean 7.3 mm, SD 0.28 mm, and mean 7.3 mm, SD 0.11 mm, respectively; Brown-Forsythe test, p 0.02). CONCLUSION We conclude that using the "socket first" "non-wobble" technique is a single surgical technical step surgeons can employ to decrease variability in tunnel aperture and size.
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Affiliation(s)
- Naser Alnusif
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
| | - Adam Hart
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
| | - Maher Baroudi
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
| | - Robert Marien
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
| | - Mark Burman
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
| | - Paul A. Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, A5-175.1, Montreal, QC H3G 1A4 Canada
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Lee DH, Kim HJ, Ahn HS, Bin SI. Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:3713-3721. [PMID: 26040654 DOI: 10.1007/s00167-015-3657-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/19/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE Although three-dimensional computed tomography (3D-CT) has been used to compare femoral tunnel position following transtibial and anatomical anterior cruciate ligament (ACL) reconstruction, no consensus has been reached on which technique results in a more anatomical position because methods of quantifying femoral tunnel position on 3D-CT have not been consistent. This meta-analysis was therefore performed to compare femoral tunnel location following transtibial and anatomical ACL reconstruction, in both the low-to-high and deep-to-shallow directions. METHODS This meta-analysis included all studies that used 3D-CT to compare femoral tunnel location, using quadrant or anatomical coordinate axis methods, following transtibial and anatomical (AM portal or OI) single-bundle ACL reconstruction. RESULTS Six studies were included in the meta-analysis. Femoral tunnel location was 18 % higher in the low-to-high direction, but was not significant in the deep-to-shallow direction, using the transtibial technique than the anatomical methods, when measured using the anatomical coordinate axis method. When measured using the quadrant method, however, femoral tunnel positions were significantly higher (21 %) and shallower (6 %) with transtibial than anatomical methods of ACL reconstruction. CONCLUSION The anatomical ACL reconstruction techniques led to a lower femoral tunnel aperture location than the transtibial technique, suggesting the superiority of anatomical techniques for creating new femoral tunnels during revision ACL reconstruction in femoral tunnel aperture location in the low-to-high direction. However, the mean difference in the deep-to-shallow direction differed by method of measurement. LEVEL OF EVIDENCE Meta-analysis, Level II.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyeong-Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 388-1, Poongnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
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Muneta T, Koga H, Nakamura T, Horie M, Watanabe T, Sekiya I. Behind-remnant arthroscopic observation and scoring of femoral attachment of injured anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2016; 24:2906-2914. [PMID: 25763852 DOI: 10.1007/s00167-015-3574-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the femoral anterior cruciate ligament (ACL) attachment based on the behind-remnant observation with a new scoring system and to investigate the characteristics of an ACL injured knee. METHODS One hundred and twenty-six ACL injured knees with four standardized arthroscopic photos and full evaluation under anaesthesia were included in the study. Sixty non-ACL injured knees were also evaluated as control. A scoring system for the femoral ACL attachment was set as follows based on behind-remnant findings; the direct insertion was divided into three portions as proximal, middle and distal. The fibrous extension from the articular surface (indirect insertion) and the severity of synovitis were also graded into 2, 1 and 0 points. The total score was 10 as full marks. The correlation between each score and total score, as well as age at surgery, gender, anterior laxity, pivot-shift test and meniscus injuries, was statistically evaluated with a significance of 0.05. RESULTS The femoral attachment score of the ACL injured knees was statistically different from that of the non-ACL injured knees. Anterior laxity was dependent only on the integrity of the proximal portion. Knee instability was significantly correlated with the status of the direct insertion. Medial and lateral meniscus injuries were correlated with the middle part and the distal part of the direct insertion, respectively. The direct insertion was less preserved in distal and articular sides. CONCLUSION Arthroscopic observation behind the remnant of the injured ACL showed clearer findings of the femoral attachment than that from the front. Behind-remnant observation greatly assists in the creation of a correct anatomical tunnel with the preserving remnant. The scoring system indicated several significant correlations between the score and preoperative patient status.
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Affiliation(s)
- Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Matsubara H, Okazaki K, Osaki K, Tashiro Y, Mizu-Uchi H, Hamai S, Iwamoto Y. Optimal entry position on the lateral femoral surface for outside-in drilling technique to restore the anatomical footprint of anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2016; 24:2758-2766. [PMID: 25429767 DOI: 10.1007/s00167-014-3460-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/20/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the optimal starting points for drilling on the lateral femoral condyle for better coverage of the anatomical footprint of the anterior cruciate ligament (ACL) using the outside-in (OI) technique in a single-bundle ACL reconstruction. METHODS Femoral tunnel drilling was simulated on three-dimensional bone models from 40 subjects by connecting the centre of the ACL footprint with various points on the lateral femoral surface. The percentage of the femoral footprint covered by apertures of the virtual tunnel sockets with 9 mm diameter was calculated for each tunnel. RESULTS The mean percentages of the femoral footprint covered by the apertures of the virtual tunnel sockets were significantly higher when drilled at 2 and 3 cm from the lateral epicondyle on a 45° line and a 60° line anterior from the proximal-distal axis than the other points. However, articular cartilage damage was occurred in nine subjects at 3 cm on a 60° line and eight subjects at 3 cm on a 45° line. Posterior wall blowout occurred in five subjects at 3 cm on a 45° line. Thus, OI drilling at 3 cm from the epicondyle has a risk of these complications. CONCLUSION During the OI drilling of the femoral tunnel, connecting the centre of the anatomical footprint of the ACL and the entry drilling point at 2 cm from the lateral epicondyle on between the 45° line and the 60° line anterior from the proximal-distal axis provides an oval-shaped socket aperture that covers and restores the native ACL footprint as nearly as possible. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hirokazu Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan.
| | - Kanji Osaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yasutaka Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
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Lee DH, Kim HJ, Ahn HS, Bin SI. Comparison of Femoral Tunnel Length and Obliquity Between Transtibial, Anteromedial Portal, and Outside-In Surgical Techniques in Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Arthroscopy 2016; 32:142-50. [PMID: 26422705 DOI: 10.1016/j.arthro.2015.07.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 06/27/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE It is unclear whether femoral tunnel length and obliquity differ after transtibial and independent femoral drilling techniques of anterior cruciate ligament (ACL) reconstruction. This meta-analysis therefore compared femoral tunnel length and obliquity in patients who underwent ACL reconstruction by the transtibial, anteromedial (AM) portal, and outside-in (OI) techniques. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, all studies comparing femoral tunnel length and obliquity with various measurement tools-from direct measurement to imaging methods such as plain radiography, computed tomography, or magnetic resonance imaging-in patients who underwent reconstruction by the transtibial or independent femoral drilling (AM portal or OI) techniques were included. RESULTS Fourteen studies were included in the meta-analysis. The femoral tunnel length was 7.8 to 11.0 mm longer (P < .05) and coronal obliquity was 7.5° to 29.1° more vertical (P < .05) with the transtibial technique than with the AM portal or OI technique. Femoral tunnel and graft obliquity in the sagittal plane, however, did not differ significantly (P > .05). CONCLUSIONS ACL reconstruction using the AM portal and OI femoral drilling techniques resulted in a shorter length and greater coronal obliquity of the femoral tunnel than did the transtibial technique. However, these 3 femoral drilling techniques resulted in similar obliquities of the femoral tunnel and graft in the sagittal plane. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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A phenomenological contact model: Understanding the graft–tunnel interaction in anterior cruciate ligament reconstructive surgery. J Biomech 2015; 48:1844-51. [DOI: 10.1016/j.jbiomech.2015.04.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
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Affiliation(s)
- John A Tanksley
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908
| | - Richard Ma
- Missouri Orthopaedic Institute, 1100 Virginia Avenue, Columbia, MO 65212
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, Kaufmann Medical Building, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908
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Boddu CK, Arif SK, Hussain MM, Sankaranarayanan S, Hameed S, Sujir PR. Prevention of graft-tunnel mismatch during anatomical anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Bone Joint J 2015; 97-B:324-8. [DOI: 10.1302/0301-620x.97b3.34653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Graft-tunnel mismatch of the bone-patellar tendon-bone (BPTB) graft is a major concern during anatomical anterior cruciate ligament (ACL) reconstruction if the femoral tunnel is positioned using a far medial portal technique, as the femoral tunnel tends to be shorter compared with that positioned using a transtibial portal technique. This study describes an accurate method of calculating the ideal length of bone plugs of a BPTB graft required to avoid graft–tunnel mismatch during anatomical ACL reconstruction using a far medial portal technique of femoral tunnel positioning. Based on data obtained intra-operatively from 60 anatomical ACL reconstruction procedures, we calculated the length of bone plugs required in the BPTB graft to avoid graft–tunnel mismatch. When this was prevented in all the 60 cases, we found that the mean length of femoral bone plug that remained in contact with the interference screw within the femoral tunnel was 14 mm (12 to 22) and the mean length of tibial bone plug that remained in contact with the interference screw within the tibial tunnel was 23 mm (18 to 28). These results were used to validate theoretical formulae developed to predict the required length of bone plugs in BPTB graft during anatomical ACL reconstruction using a far medial portal technique. Cite this article: Bone Joint J 2015;97-B:324–8.
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Affiliation(s)
- C. K. Boddu
- Lenox Hill Hospital, 210
East 64th Street, 4th Floor, New
York, New York 10065, USA
| | - S. K. Arif
- Yenepoya Medical College, Mangalore, Karnataka, India
| | - M. M. Hussain
- Yenepoya Medical College, Mangalore, Karnataka, India
| | | | - S. Hameed
- Hamad Medical Corporation, Doha, Qatar
| | - P. R. Sujir
- Kasturba Medical College, Mangalore, Karnataka, India
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A comparison of distal femoral physeal defect and fixation position between two different drilling techniques for transphyseal anterior cruciate ligament reconstruction. J Pediatr Orthop B 2015; 24:106-13. [PMID: 25622235 DOI: 10.1097/bpb.0000000000000143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The defect of the femoral tunnel at the level of the physeal scar during transtibial and anteromedial portal (AMP) drilling for transphyseal anterior cruciate ligament reconstruction was compared. Five matched pairs of knees (n=10) were drilled, and computed tomography was used to evaluate tunnel position and size at the level of the physeal scar. Significant radiographic changes were observed, including tunnel defect area at the physeal scar: 0.44 cm (1.2%) in the transtibial group versus 0.99 cm (2.7%) in the AMP group (P=0.008). AMP drilling creates a larger and more lateral tunnel defect at the level of the physeal scar.
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