Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction: Anteromedial Portal versus Transtibial Technique—A Randomized Clinical Trial

Purpose The purpose of this study was to investigate, through three-dimensional computed tomography (3D-CT), the accuracy of femoral tunnel positioning in patients undergoing anterior cruciate ligament (ACL) reconstruction, comparing transtibial (TT) and anteromedial (AM) techniques. Methods We evaluated postoperative 3D-CT scans of 26 patients treated with ACL reconstruction with hamstrings autograft using a low accessory AM portal technique and 26 treated with the TT technique. The position of the femoral tunnel center was measured with the quadrant method. Results Using quadrant method on CT scans, femoral tunnels were measured at a mean of 32.2 and 28.1% from the proximal condylar surface (parallel to Blumensaat line) and at a mean of 31.2 and 15.1% from the notch roof (perpendicular to Blumensaat line) for the AM and TT techniques, respectively. Conclusion The AM portal technique provides more anatomical graft placement than TT techniques. Level of Evidence Level I, randomized clinical study.

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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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00076 ◽

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]

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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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Reposta à carta ao editor referente aos comentários sobre o artigo “Radiological Evaluation of the Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction”

Revista Brasileira de Ortopedia ◽

10.1055/s-0040-1722595 ◽

2021 ◽

Vol 56 (01) ◽

pp. 127-127

Author(s):

Luciano Rodrigo Peres ◽

Matheus Silva Teixeira ◽

Caetano Scalizi Júnior ◽

Wolf Akl Filho

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Radiological Evaluation ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate ◽

Tunnel Positioning

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

Journal of Orthopaedic Surgery ◽

10.1177/1602400302 ◽

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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Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

10.21203/rs.3.rs-660355/v1 ◽

2021 ◽

Author(s):

Lifeng Yin ◽

Hua Zhang ◽

Junbo Liu ◽

xingyu zhang ◽

zhengxing wen ◽

...

Keyword(s):

Computed Tomography ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Ct Images ◽

Graft Fixation ◽

Bone Preservation ◽

Anterior Cruciate ◽

Graft Insertion

Abstract Background: Cortical suspensory femoral fixation is commonly performed for graft fixation of the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. This study aimed to compare the morphology of femoral tunnel and graft insertion between fixed-length loop devices (FLD) and adjustable-length loop devices (ALD) using computed tomography (CT) images on the first day after hamstring ACL reconstruction. Methods: Overall, 94 patients who underwent ACL reconstruction from January 2016 to January 2021 were included. For femoral graft fixation, FLD (Smith & Nephew, ENDOBUTTON) and ALD (DePuy Synthes, Mitek sports medicine, RIGIDLOOP Adjustable cortical system) were used in 56 and 38 patients, respectively (FLD and ALD groups). For evaluation of the morphology of the humeral tunnel and graft depth, CT scans were performed immediately on the first postoperative day. The gap distance between the top of the graft and the socket tunnel end, the length of lateral bone preservation, and the depth of graft insertion were measured on the CT images. Results: The gap distance and bone preservation significantly differed between the two groups (1.90±1.81 mm and 14.35±4.67 mm in ALD groups; 7.08±2.63 mm and 7.35±3.62 mm in FLD groups, respectively; both P values < 0.01). The graft insertion depth did not significantly differ between the groups. Conclusion: The ALD group had a smaller gap distance, better bone preservation, and a similar graft insertion length in the femoral tunnel when compared to the FLD group. Based on these findings, ALD might be better for bone preservation and tunnel utilization in patients with short femoral tunnels. Trial registration: retrospectively registered

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Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06392-9 ◽

2020 ◽

Author(s):

Adam T. Hexter ◽

Anita Sanghani-Kerai ◽

Nima Heidari ◽

Deepak M. Kalaskar ◽

Ashleigh Boyd ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Stromal Cells ◽

Femoral Tunnel ◽

Platelet Rich Plasma ◽

Cruciate Ligament ◽

Control Group ◽

Tendon Allograft ◽

Tunnel Diameter ◽

Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

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