Postoperative evaluation of femoral tunnel position in ACL reconstruction: plain radiography versus computed tomography

AbstractThe techniques available to locate the femoral tunnel during anterior cruciate ligament (ACL) reconstruction have notable limitations. To evaluate whether the femoral tunnel center could be located intraoperatively with a ruler, using the posterior apex of the deep cartilage (ADC) as a landmark. This retrospective case series included consecutive patients with ACL rupture who underwent arthroscopic single-bundle ACL reconstruction at the Department of Orthopedics, Beijing Tongren Hospital between January 2014 and May 2018. During surgery, the ADC of the femoral lateral condyle was used as a landmark to locate the femoral tunnel center with a ruler. Three-dimensional computed tomography (CT) was performed within 3 days after surgery to measure the femoral tunnel position by the quadrant method. Arthroscopy was performed 1 year after surgery to evaluate the intra-articular conditions. Lysholm and International Knee Documentation Committee (IKDC) scores were determined before and 1 year after surgery. The final analysis included 82 knees of 82 patients (age = 31.7 ± 6.1 years; 70 males). The femoral tunnel center was 26 ± 1.5% in the deep-shallow (x-axis) direction and 31 ± 3.1% in the high-low (y-axis) direction, close to the “ideal” values of 27 and 34%. Lysholm score increased significantly from 38.5 (33.5–47) before surgery to 89 (86–92) at 1 year after surgery (p < 0.001). IKDC score increased significantly from 42.5 (37–47) before surgery to 87 (83.75–90) after surgery (p < 0.001). Using the ADC as a landmark, the femoral tunnel position can be accurately selected using a ruler.

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Reliability of 3-Dimensional Computed Tomography for Application of the Bernard Quadrant Method in Femoral Tunnel Position Evaluation After Anatomic Anterior Cruciate Ligament Reconstruction

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2016.01.043 ◽

2016 ◽

Vol 32 (8) ◽

pp. 1660-1666 ◽

Cited By ~ 10

Author(s):

Dong Hwi Kim ◽

Won-bong Lim ◽

Sung-won Cho ◽

Chae-won Lim ◽

Suenghwan Jo

Keyword(s):

Computed Tomography ◽

Ligament Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Cruciate Ligament Reconstruction ◽

Tunnel Position ◽

3 Dimensional ◽

Quadrant Method ◽

Femoral Tunnel Position ◽

Anterior Cruciate

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How anatomical is our tunnel? A three dimensional CT evaluation of femoral tunnel in anatomic anteromedial single bundle anterior cruciate ligament reconstruction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192679 ◽

2019 ◽

Vol 5 (4) ◽

pp. 656 ◽

Cited By ~ 1

Author(s):

Saurabh Dutt ◽

Vinod Kumar

Keyword(s):

Acl Reconstruction ◽

Femoral Tunnel ◽

Femoral Condyle ◽

Three Dimensional ◽

Single Bundle ◽

Tunnel Position ◽

Significant Difference ◽

Femoral Tunnel Position ◽

Distal Direction ◽

Anterior Direction

Background: ACL reconstruction has become a common orthopaedic procedure. The anatomy and biomechanics of ACL have been one of the most researched and debated topics in the orthopaedic literature. This has implication on the surgical procedure too with shift from traditional transtibial to more anatomic anteromedial ACL reconstruction. Anteromedial technique results in more anatomic femoral tunnel with graft positioned at the native insertion site. The tunnel position is crucial for better outcome after ACL reconstruction. The purpose of the study was to ascertain the femoral tunnel position made by anatomic single bundle reconstruction with the help of three dimensional computer tomography.Methods: A prospective case series involving thirty patients with ACL tear who underwent anteromedial single bundle ACL reconstruction. Computer tomography scans were performed on thirty knees that underwent single bundle anteromedial ACL reconstruction. Three dimensional models were created and the data was analyzed according to coordinate system method. Femoral tunnel position was measured in proximal to distal and posterior to anterior directions. This data was compared with the already published reference data on anatomical tunnel position.Results: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.Conclusions: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.

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A Simple Evaluation of Anterior Cruciate Ligament Femoral Tunnel Position

The American Journal of Sports Medicine ◽

10.1177/0363546511420128 ◽

2011 ◽

Vol 39 (12) ◽

pp. 2611-2618 ◽

Cited By ~ 66

Author(s):

Kenneth David Illingworth ◽

Daniel Hensler ◽

Zachary Mark Working ◽

Jeffrey Alexander Macalena ◽

Scott Tashman ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Inclination Angle ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

3D Ct ◽

Tunnel Position ◽

Femoral Tunnel Position ◽

Anterior Cruciate ◽

Tunnel Angle

Background: Postoperative determination of tunnel position after anterior cruciate ligament (ACL) reconstruction can be challenging. Hypothesis: The femoral tunnel angle and inclination angle are reliable methods for evaluating tunnel position after ACL reconstruction while aiding in determining whether an ACL reconstruction falls outside an anatomic range as defined on 3-dimensional (3D) computed tomography (CT). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Fifty patients were included who received single-bundle ACL reconstructions with postoperative flexion weightbearing radiographs, magnetic resonance imaging (MRI), and CT scans. Femoral tunnel angles were determined from posterior-to-anterior postoperative radiographs, and inclination angles were determined from sagittal MRI. The ACL reconstructions were grouped by surgical technique, transtibial (TT) or tibial tunnel independent (TTI), and as either falling inside or outside an anatomic range on 3D CT. Results: Patients with tunnel positions within an anatomic range, as previously defined, had a larger femoral tunnel angle (39.3° ± 4.2°) and smaller inclination angle (49.5° ± 2.7°) than patients who fell outside an anatomic range (17.2° ± 12.5° and 62.3° ± 7.8°, respectively) ( P < .001). Patients in the TTI group had a larger femoral tunnel angle (37.6° ± 9.30°) and smaller inclination angle (51.8° ± 6.5°) than those in the TT group (14.2° ± 9.3° and 63.5° ± 7.2°, respectively) ( P < .001). Posterior-to-anterior femoral tunnel position was negatively correlated with femoral tunnel angle ( P < .001, r = .78) and positively correlated with inclination angle ( P < .001, r = .74). Based on a receiver operating characteristic (ROC) curve, a femoral tunnel angle of 32.7° (100% sensitivity and 85% specificity) and inclination angle of 55° (100% sensitivity and 87.5% specificity) were determined to distinguish ACL reconstructions that fell either within or outside an anatomic range on 3D CT. Conclusion: Femoral tunnel angle and inclination angle can be reliably determined from both posterior-to-anterior radiographs and sagittal MRI and provide a useful metric for characterizing femoral tunnel position.

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