The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction

2009 ◽  
Vol 18 (9) ◽  
pp. 1164-1168 ◽  
Author(s):  
Konsei Shino ◽  
Tomoyuki Suzuki ◽  
Takehiko Iwahashi ◽  
Tatsuo Mae ◽  
Norimasa Nakamura ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Femoral Tunnel Drilling

scholarly journals Can an Anatomical ACL Reconstruction be Performed with Two Standart Portals?

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0012
Author(s):  
Cem Coşkun Avcı ◽  
Hüseyin Koca ◽  
Necdet Sağlam ◽  
Tuhan Kurtulmuş ◽  
Gürsel Saka
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Coronal Plane ◽  
Radiographic Measurement ◽  
Single Bundle ◽  
Anteromedial Portal ◽  
Tunnel Placement ◽  
Tunnel Length ◽  
Femoral Tunnel Drilling ◽  
Tunnel Angle

Objectives: Recent studies have demonstrated that ACL reconstruction via anatomic tunnel placement would provide superior stability. In order to achieve an anatomic femoral tunnel, accessory anteromedial portal (three-portal tecnique) and medial Hoffa excision is necessary. Femoral tunnel drilling through a far anteromedial portal facilitates anatomic tunnel placement but can also results in shorter femoral tunnel and articular cartilage damage of the medial femoral condyle. Our purpose in this study was to evaluate whether an anatomic single bundle ACL reconstruction can be performed with the use of the two standart portals (anteromedial and anterolateral). Methods: Fifty seven patient underwent single bundle ACL reconstruction in our clinic between 2012-2014, with the use of either standart portals or three-portal tecnique. We measured the tunnel length and and femoral tunnel angle in coronal plane to assess the reconstruction. Two portals group included thirty -three patients (twenty-nine males, four females with a mean age of 27±2,4) and three portals group included twenty–four patients (twenty-three males, one female with a mean age of 26±2,9). All patients were evaluated with computerized tomography (CT) scans to determine femoral tunnel length and obliquity. Tunnel length was defined as the distance between the intra-articular and extra-articular tunnel apertures in coronal sections. Femoral tunnel angle was measured in the coronal plane on AP radiographs of the knee. For statistical analysis, student t test was used for normal categorical data. A p value of <0.05 was considered significant. Results: Average tunnel length was 44.2 ±6.8 mm (range: 32.6-55.2) in two portals group and 32.8±7.9 mm (range: 24.8-43.2) in three portal group. The average tunnel length in three portal group was significantly smaller (p<0.05). According to radiographic measurement on the AP view, femoral tunnel angle averaged 48.20±7.10 (range:38.60-56.10) in two portals group and 47.20±6,30 (range: 39.40-55.20) in three portals group. This difference was not statistically significant (p=0.2). Conclusion: Femoral tunnels drilled with standart two-portal tecnique were longer than three-portal tecnique. However, femoral tunnel angles was not different in two groups. Tunnel characteristic in terms of anatomic position was obtained with standart two-portal tecnique. Consequently, femoral tunnels can be placed anatomically with standart portals.

scholarly journals Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Leena Metso ◽  
Kirsi-Maaria Nyrhinen ◽  
Ville Bister ◽  
Jerker Sandelin ◽  
Arsi Harilainen
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Clinical Results ◽  
Femoral Tunnel Drilling

scholarly journals Anatomıc femoral tunnel drilling in acl reconstruction without using of an accessory medial portal and evaluation of femoral tunnel positioning using 3-d computed tomography

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007
Author(s):  
Fatih Karaaslan ◽  
Sinan Karaoğlu
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
3D Ct ◽  
Quadrant Method ◽  
Anterior Cruciate ◽  
Femoral Tunnel Drilling ◽  
Transportal Technique

Background and Purpose: Characterization of the insertion site anatomy in anterior cruciate ligament reconstruction has recently received increased attention in the literature, coinciding with a growing interest in anatomic reconstruction. The purpose of this study is to report a modified novel transportal technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT). Materials-Methods: We evaluated 11 patients who underwent primary ACL reconstruction using a modified transportal technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT postoperatively according to the quadrant method by three orthopedic surgeons. Results: According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 33,49% ± 5,59% from the proximal condylar surface (parallel to the Blumensaat line) and 32,93% ± 3,82% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0,991and 0,858, respectively with 0,975 – 0,997%95 CI) and intraobserver reliability (ICC, 0.875 and 0.893, respectively with 0,663 – 0,956%95 CI). Conclusions: Our modified transportal technique is anticipated to provide anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques. This technique is reproducible and also easier to perform than classic transportal technique does not need extra arthroscopic portal. [Figure: see text]

scholarly journals Figure-of-nine position: A convenience trick for standard technique of ACL reconstruction

2021 ◽  
Vol 2 ◽  
pp. 145-149
Author(s):  
Ravinder Kant Manocha ◽  
Ranjan Kumar Gupta
Keyword(s):  
Clinical Outcome ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Standard Technique ◽  
Alternative Position ◽  
Femoral Tunnel Drilling

While position of leg during arthroscopy may not affect clinical outcome of a well-done ACL reconstruction, better view during reconstruction, more efficient fluid ingress in position of hyperflexion during femoral tunnel drilling, decreased crowding of instrumentation, and convenient disposition during surgery for surgeon and assistant with need for reduced logistics are some advantages of figure of nine position. Adoption of this alternative position in arthroscopic ACL reconstruction is easy because it does not require alteration to standard technique of ACL reconstruction. There are even greater merits for considering this position for three portal medial viewing medial drilling techniques.

Evaluation of Tibial Tunnel Location with the Femoral Tunnel Created Behind the Resident's Ridge in Transtibial Anterior Cruciate Ligament Reconstruction

2021 ◽  
Author(s):  
Tsuneari Takahashi ◽  
Tomohiro Saito ◽  
Tatsuya Kubo ◽  
Ko Hirata ◽  
Hideaki Sawamura ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Anterior Cruciate ◽  
Tunnel Positions ◽  
Tunnel Angle ◽  
Coronal View

AbstractFew studies have determined whether a femoral bone tunnel could be created behind the resident's ridge by using a transtibial (TT) technique-single bundle (SB)-anterior cruciate ligament (ACL) reconstruction. The aim of this study was to clarify (1) whether it is possible to create a femoral bone tunnel behind the resident's ridge by using the TT technique with SB ACL reconstruction, (2) to define the mean tibial and femoral tunnel angles during anatomic SB ACL reconstruction, and (3) to clarify the tibial tunnel inlet location when the femoral tunnel is created behind resident's ridge. Arthroscopic TT-SB ACL reconstruction was performed on 36 patients with ACL injuries. The point where 2.4-mm guide pin was inserted was confirmed, via anteromedial portal, to consider a location behind the resident's ridge. Then, an 8-mm diameter femoral tunnel with a 4.5-mm socket was created. Tunnel positions were evaluated by using three-dimensional computed tomography (3D-CT) 1 week postoperatively. Quadrant method and the resident's ridge on 3D-CT were evaluated to determine whether femoral tunnel position was anatomical. Radiological evaluations of tunnel positions yielded mean ( ±  standard deviation) X- and Y-axis values for the tunnel centers: femoral tunnel, 25.2% ± 5.1% and 41.6% ± 10.2%; tibial tunnel, 49.2% ± 3.5%, and 31.5% ± 7.7%. The bone tunnels were anatomically positioned in all cases. The femoral tunnel angle relative to femoral axis was 29.4 ± 5.5 degrees in the coronal view and 43.5 ± 8.0 degrees in the sagittal view. The tibial tunnel angle relative to tibial axis was 25.5 ± 5.3 degrees in the coronal view and 52.3 ± 4.6 degrees in the sagittal view. The created tibial bone tunnel inlet had an average distance of 13.4 ± 2.7 mm from the medial tibial joint line and 9.7 ± 1.7 mm medial from the axis of the tibia. Femoral bone tunnel could be created behind the resident's ridge with TT-SB ACL reconstruction. The tibial bone tunnel inlet averaged 13.4 mm from the medial tibial joint line and 9.7 mm medial from the tibia axis.

scholarly journals Correlation of Femoral Tunnel Length with Body Height, Limb Length, and Thigh Length in Indian Patients Undergoing Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 24 (3) ◽  
pp. 286-288
Author(s):  
Ravi Gupta ◽  
Anubhav Malhotra ◽  
Pawan Kumar ◽  
Gladson David Masih
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Body Height ◽  
Limb Length ◽  
Tunnel Length ◽  
Indian Patients ◽  
Anterior Cruciate ◽  
Hamstrings Tendon

Purpose To measure the femoral tunnel length created through a far medial portal and determine its correlation with body height, limb length, and thigh length in 404 Indian patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods 364 male and 40 female Indian patients aged 18 to 51 (mean, 26.8) years underwent ACL reconstruction by a single surgeon using the hamstrings tendon autograft. Their body height, limb length, and thigh length were measured by a single assessor, as was the femoral tunnel length. Results The mean femoral tunnel length was 34.5 mm. It was <30 mm in 28 patients and <25 mm in 2 patients. The correlation coefficients of the femoral tunnel length with body height, limb length, and thigh length were 0.485 (p<0.0001), 0.426 (p<0.0001), and 0.304 (p<0.0001). No patient had posterior wall blowout fracture. Conclusion The femoral tunnel length positively correlated with body height, limb length, and thigh length in 404 Indian patients.

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