The correlation of femoral tunnel length with the height and area of the lateral wall of the femoral intercondylar notch in anatomical single-bundle ACL reconstruction

2016 ◽  
Vol 25 (5) ◽  
pp. 1632-1637 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Keinosuke Ryu ◽  
Makoto Suruga ◽  
Shin Aizawa ◽  
Freddie H. Fu
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Lateral Wall ◽  
Single Bundle ◽  
Intercondylar Notch ◽  
Tunnel Length ◽  
Femoral Intercondylar Notch

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 Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle during Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0009
Author(s):  
Sang Hak Lee ◽  
Kyung Hk Yoon ◽  
Chan Il Bae
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Posterior Wall ◽  
Width Ratio ◽  
Single Bundle ◽  
Tunnel Length ◽  
Tunnel Position ◽  
The Mean

Purpose: Tibial tunnel-independent drilling has attracted increased interest in recent years for anatomic anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the geometry and position of the femoral tunnel between the anteromedial portal (AMP) and outside-in (OI) techniques after anatomic single-bundle ACL reconstruction. Methods: We prospectively evaluated 82 patients undergoing single-bundle ACL reconstruction with hamstring tendon autografts using either the AMP (n=40) or OI (n=42) technique. The locations of the tibial and femoral tunnel apertures were assessed by immediate postoperative 3-dimensional computed tomography (3D CT) imaging with OsiriX imaging software. The femoral graft bending angle, femoral tunnel aperture shape (height/width ratio), femoral tunnel length, and posterior wall breakage were also measured. Results: The two techniques did not differ significantly in the femoral tunnel position perpendicular to the Blumensaat line. However, the mean femoral tunnel position parallel to the Blumensaat line was more caudally positioned in the AMP group than in the OI group (P=0.025) The two groups did not differ significantly in tibial tunnel position. The mean femoral tunnel length did not differ between the AMP (36.1±0.33 mm) and OI groups (35.6±0.37 mm; P=0.548) The mean femoral graft angle in the OI group (99.6°±7.1°) was significantly more acute than that of the AMP group (108.9°±10.2°) (p < 0.0001). The mean height/width ratio of the AMP group (1.21±0.20) was significantly more ellipsoidal than that of the OI group (1.07±0.09) (p < 0.0001). Posterior wall breakage was detected in 3 cases (7.5%), all in the AMP group. Conclusions: After single-bundle anatomic ACL reconstruction, 3D CT showed a significantly shallower femoral tunnel in the AMP group than in the OI group. The AMP group had a more ellipsoidal femoral tunnel with a risk of posterior wall breakage than the OI group. The OI group showed a more acute bending angle of the femoral tunnel than the AMP group. [Figure: see text][Figure: see text]

Femoral tunnel length in anatomical single-bundle ACL reconstruction is correlated with height, weight, and knee bony morphology

2018 ◽  
Vol 27 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Bunsei Goto ◽  
Tatsumasa Okano ◽  
Keinosuke Ryu ◽  
Freddie H. Fu
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Single Bundle ◽  
Tunnel Length ◽  
Bony Morphology

Sagittal femoral condyle morphology correlates with femoral tunnel length in anatomical single bundle ACL reconstruction

2017 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Freddie H. Fu ◽  
Keinosuke Ryu ◽  
Makoto Suruga ◽  
Yoshiyuki Yahagi ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Femoral Condyle ◽  
Single Bundle ◽  
Tunnel Length

scholarly journals Optimal Condition to Create Femoral Tunnel Considering Combined Influence of Knee Flexion and Transverse Drill Angle in Anatomical Single-Bundle ACL Reconstruction Using Medial Portal Technique: 3D Simulation Study

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Sung-Hwan Kim ◽  
Sung-Jae Kim ◽  
Chong Hyuk Choi ◽  
Dohyun Kim ◽  
Min Jung
Keyword(s):  
Optimal Condition ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Femoral Tunnel ◽  
Flexion Angle ◽  
Single Bundle ◽  
Tunnel Length ◽  
Bending Angle ◽  
Graft Bending Angle ◽  
Transportal Technique

There has been no previous study using three-dimensional (3D) measurement on femoral tunnel characteristics according to the combined influence of various flexion angles of knee and transverse drill angles in single-bundle ACL reconstruction with transportal technique. The purpose of this study was to determine optimal condition of knee flexion angle and transverse drill angle to create secure femoral tunnel in single-bundle ACL reconstruction with transportal technique considering tunnel length, tunnel wall breakage, and graft bending angle. This study was conducted using simulation of 3D computed tomography of thirty subjects. Three variables of femoral tunnel changed according to combined influence of four flexion angles of knee and three transverse drill angles were measured: tunnel length, wall breakage, and graft bending angle. There was no case of short femoral tunnel less than 25 mm at 120° and 130° of flexion. There was no case of breakage of femoral tunnel at 120° of flexion with maximum transverse drill angle (MTA) and MTA-10° and at 130° of flexion. Considering effect on graft bending angle, decrease of flexion angle and transverse drill angle could be appropriate in creating femoral tunnel. Increased flexion angle and transverse drill angle secured femoral tunnel having sufficiently long length without wall breakage. However, avoiding excessive flexion angle and maximum transverse drill angle could be recommended because they tended to cause more acute graft bending angle.

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.

ACL footprint size is correlated with the height and area of the lateral wall of femoral intercondylar notch

2012 ◽  
Vol 21 (4) ◽  
pp. 789-796 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Kenji Shirakura ◽  
Hiroshi Yorifuji ◽  
Shin Aizawa ◽  
Tohru Murakami ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Intercondylar Notch ◽  
Femoral Intercondylar Notch

scholarly journals Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110018
Author(s):  
Sung-Jae Kim ◽  
Si Young Song ◽  
Tae Soung Kim ◽  
Yoon Sang Kim ◽  
Seong-Wook Jang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Contact Stress ◽  
Femoral Tunnel ◽  
Single Bundle ◽  
Central Group ◽  
Acl Graft ◽  
Anterior Aspect ◽  
Extended Position ◽  
The Difference ◽  
Stress Patterns

Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) ( P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.

scholarly journals Modified Transtibial versus Anteromedial Portal Technique in Single Bundle ACL Reconstruction

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0002
Author(s):  
Emiliano Alvarez Salinas ◽  
Horacio Rivarola Etcheto ◽  
Cristian Collazo Blanchod ◽  
Gonzalo Escobar ◽  
Jesuan Zordan ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Sagittal Plane ◽  
Femoral Tunnel ◽  
Average Distance ◽  
Average Diameter ◽  
Single Bundle ◽  
Transtibial Technique ◽  
Group I ◽  
Group Ii ◽  
Transportal Technique

Objectives: The aim of this study is to determine whether it is possible to achieves a similar anatomical placement of the femoral tunnel with a modified transtibial ACL single bundle reconstruction tecnique compared to anteromedial transportal technique. Results were evaluated by tomographic comparisons between patients from both groups. Methods: 36 patients (36 knees) who were candidates for an ACL single bundle reconstruction with patellar bone graft were included in the study. Patients were randomly allocated using a computerized sequence into two groups. 18 patients were assigned each group (modified transtibial vs AM transportal technique). Surgery was performed by the same surgical team in both groups. Femoral tunnel quadrant placement, oblicuity in the coronal and sagittal planes and diameter of the femoral tunnel were assesed tomographically blinded by two observers and statistical comparison between groups was realized. Results: Average distance measured from posterior edge of the condyle to the femoral tunnel ( measured as a proportion respect to the T line) was similar in both groups ( Group I : 32.7 % +- 5.1% ; Group 2: 32.4 % +-4.4% , p = 0.85). Average distance measured from the Blumensaat line to the femoral tunnel (measured as a proportion respect to the H line) was similar in both groups ( Group I: 28.5% 4.49 % Group II , 31.5% of 4.83% p = 0.06). Average angulation values of the femoral tunnel in the coronal plane were lower in Group I than in Group II (Group I = 34.8 ° range 32.7 ° - 38.6 ° and 41.2 ° range Group II 36.7 ° - 43.1 ° P = 0.0016 ). Average angulation values of the femoral tunnel in the sagittal plane were similar in both groups (Group I 40.2 ° range 38.4 ° - 43.4 ° ; Group II 38 1 ° range 36.6 ° - 40.2 ° p = 0.17).. The average diameter of the femoral tunnel was significantly higher in group I than in Group II (Group I 11 mm 0.84 mm and 10.2 mm Group II 0.65mm p = 0.007) . Conclusion: The modified transtibial technique for single bundle ACL reconstruction has proved to be suitable to reproduce the anatomic placement of the femoral tunnel compared to the transportal AM technique.

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