Correlation Between Endobutton Loop Length and Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Nam-Hong Choi ◽  
Jong-Seok Oh ◽  
Seok-Hyun Jung ◽  
Brian N. Victoroff
Keyword(s):  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Significant Difference ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Background: Previous reports have shown that graft fixation with the Endobutton is associated with tunnel widening because it provides distant fixation rather than aperture fixation. Hypothesis: A longer loop of the Endobutton results in greater tunnel widening than a shorter loop. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 171 consecutive patients underwent hamstring anterior cruciate ligament (ACL) reconstruction fixed with the Endobutton. They were followed for a minimum of 2 years postoperatively. A 15-mm loop was used in 20 patients, a 20-mm loop in 53, a 25-mm loop in 58, and a >30-mm loop in 40. On anterior-posterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 2 years after surgery were compared with the diameter of the reamer used at surgery. The measured diameter of the tibial tunnel at 2 years after surgery was compared with measurements taken on the immediate postoperative day. The center of the tibial tunnel and direction of the ACL graft were also measured. Postoperative knee stability was evaluated using the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. All measurements were compared among the 4 groups according to the length of the Endobutton loop. Results: The mean ± standard deviation (SD) diameter of the femoral tunnel increased by 50.7% ± 23.3% and 37.0% ± 18.8% on AP and lateral radiographs at 2 years after surgery, respectively. The mean ± SD diameter of the tibial tunnel increased by 40.8% ± 19.3% and 46.4% ± 22.6% on AP and lateral radiographs, respectively. No significant difference in tunnel widening was present according to the length of the Endobutton loop. There were no significant differences in the average center of the tibial tunnel or the average angle of the direction of the ACL graft among the 4 groups. There was no significant difference in Lachman test results, postoperative KT-1000 arthrometer side-to-side differences, Lysholm score, and Tegner activity scale score among the 4 groups. The group with a >30-mm loop showed a significant difference in the pivot-shift test than the other 3 groups ( P = .023). Conclusion: A longer Endobutton loop did not result in greater tunnel widening than a shorter loop. Long fixation distance may not be associated with tunnel widening after hamstring ACL reconstructions.

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

2019 ◽  
Vol 33 (05) ◽  
pp. 445-451
Author(s):  
Shuji Taketomi ◽  
Hiroshi Inui ◽  
Ryota Yamagami ◽  
Kohei Kawaguchi ◽  
Keiu Nakazato ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Tendon Length ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

AbstractThe purpose of this study was to retrospectively investigate the effects of variations in the length of the tendon within the tibial tunnel on tunnel widening (TW) following anatomical anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft. In total, 68 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. The patients were divided into two groups according to the length of the tendon within the tibial tunnel: group S (n = 30; tendon length, < 10 mm) and group L (n = 38; tendon length, ≥ 10 mm). Tunnel aperture area was measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and tibial TW (%) was calculated. The correlation coefficient between the length of the tendon within the tibial tunnel and tibial TW was also calculated. Clinical assessment was performed 1 year postoperatively, corresponding to the period of CT assessment, which involved the evaluation of the Lysholm's score, measurement of anterior knee stability using a KneeLax3 arthrometer, and the pivot-shift test. A weak positive correlation was observed between the length of the tendon within the tibial tunnel and tibial TW (r = 0.270, p = 0.026). Mean tibial tunnel aperture area increased by 19.3 ± 17.4% and 35.8 ± 25.4% in the groups S and L, respectively. TW in the group L was significantly greater than that in the group S (p = 0.004). No significant difference was observed between the two groups in any clinical outcomes. In conclusion, a longer tendinous portion within the tibial tunnel resulted in a greater tibial TW following anatomical ACL reconstructions using a BTB graft.

scholarly journals Comparing Knee Laxity After Anatomic Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Versus Semitendinosus Tendon Graft

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110148
Author(s):  
Katrin Karpinski ◽  
Martin Häner ◽  
Sebastian Bierke ◽  
Theresa Diermeier ◽  
Wolf Petersen
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Pivot Shift Test ◽  
Significant Difference ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction. Purpose: To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft. Study Design: Cohort study; Level of evidence, 2. Methods: We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate. Results: The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores ( P = .694) or the Lysholm score ( P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups. Conclusion: Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices

2016 ◽  
Vol 45 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Nam-Hong Choi ◽  
Bong-Seok Yang ◽  
Brian N. Victoroff
Keyword(s):  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Knee Laxity ◽  
Loop Group ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Kt 1000 ◽  
The Mean

Background: Few studies have compared clinical and radiological outcomes after hamstring anterior cruciate ligament (ACL) reconstruction with fixed-loop and adjustable-loop cortical suspension devices. Purpose/Hypothesis: The purpose of this retrospective study was to compare clinical outcomes and tunnel widening after hamstring ACL reconstructions with fixed- and adjustable-loop cortical suspension devices. The hypothesis was that compared with femoral graft fixation with the fixed-loop device, fixation with the adjustable-loop device would show similar clinical outcomes and would result in less tunnel widening after hamstring ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 117 consecutive patients underwent hamstring ACL reconstruction at a single institution. The fixed-loop cortical suspension device was used in 67 patients, and the adjustable-loop cortical suspension device was used in 50 patients. All patients were observed for a minimum of 2 years. Postoperative knee laxity was evaluated with the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed by use of the Lysholm score and the Tegner activity scale. On anteroposterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 1 year after surgery were compared with the diameter of the reamer used at surgery. The measured diameters of the tibial tunnel at 1 year after surgery were compared with those taken immediately after surgery. Results: The mean KT-1000 arthrometer laxity measurement was 1.5 ± 1.8 mm in the fixed-loop group and 1.2 ± 2.3 mm in the adjustable-loop group ( P = .530). Results of postoperative knee laxity evaluations and functional outcomes from both groups showed no statistically significant differences. However, the fixed-loop group showed significantly better stability in the pivot-shift test than did the adjustable-loop group ( P = .018). On AP radiographs, the mean diameter of the femoral and tibial tunnels increased by 42.2% ± 15.9% and 37.0% ± 17.8%, respectively, in the fixed-loop group and by 43.0% ± 15.4% and 36.8% ± 18.2% in the adjustable-loop group. On lateral radiographs, the mean diameter of the femoral and tibial tunnels increased by 38.1% ± 14.8% and 39.9% ± 13.8%, respectively, in the fixed-loop group and by 35.8% ± 12.2% and 38.1% ± 21.0% in the adjustable-loop group. No significant differences were found between the 2 groups in postoperative femoral and tibial tunnel widening on AP radiographs ( P = .801 and .951, respectively) or lateral radiographs ( P = .422 and .621, respectively). Conclusion: Compared with femoral fixation by use of the fixed-loop device, femoral fixation by use of the adjustable-loop device showed similar clinical outcomes but did not reduce tunnel widening after hamstring ACL reconstructions.

Accessory Anteromedial Portal may not Provide Clinically Superior Results Compared with the Anteromedial Portal in Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 31 (08) ◽  
pp. 716-722
Author(s):  
Shu-Ming Ye ◽  
Jue-Hua Jing ◽  
Hao Lv ◽  
Ji-Sen Zhang ◽  
Xin-Zhong Xu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Anteromedial Portal ◽  
Anterior Cruciate

AbstractTechniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.

scholarly journals Platelet-Rich Plasma in Anterior Cruciate Ligament Quadriceps Tendon Bone Reconstruction—Impact of PRP Administration on Pain, Range of Motion Restoration, Knee Stability, Tibial Tunnel Widening and Functional Results

2021 ◽  
Vol 11 (9) ◽  
pp. 3993
Author(s):  
Konrad Malinowski ◽  
Michał Ebisz ◽  
Robert F LaPrade ◽  
Marcin Mostowy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Quadriceps Tendon ◽  
Functional Results ◽  
Tunnel Widening ◽  
Knee Stability ◽  
On Demand ◽  
The Mean ◽  
Anterior Cruciate

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of ACLR performed with quadriceps tendon bone (QTB) autografts. Methods: A total of 106 patients were included in this multicenter study. Fifty-two patients underwent single-bundle QTB ACLR and 54 patients underwent the same procedure with additional PRP administration. Results: Mean time of need for on-demand analgesia was 8 days in the PRP group and 11 days in no-PRP group. Symmetric full extension was restored in a mean of 40 days in the PRP group and 53 days in the no-PRP group. Ninety degrees of flexion was restored at a mean of 21 days in the PRP group and 25 days in the no-PRP group. At 18 months postoperatively, the mean side-to-side difference in anterior tibial translation with the use of an arthrometer (Rolimeter, Aircast Europa) was 1.3 mm in the PRP group vs. 2.7 mm in the no-PRP group. Mean tibial tunnel widening was 1.4 mm in the PRP group vs. 2.1 mm in the no-PRP group. The mean score in the pain section of the KOOS scale was 93 in the PRP group vs. 89 in the no-PRP group. For the IKDC scale, 53 patients in the PRP group graded A or B and 1 patient graded C. In the no-PRP group, 48 patients graded A or B and 4 patients graded C or D. Conclusions: The use of PRP in QTB ACLR may decrease the need for on-demand analgesia and accelerate ROM restoration as well as improve knee stability, lessen the extent of tibial tunnel widening and potentially diminish pain at 18 months postoperatively. Further studies will be needed to confirm all authors’ conclusions.

scholarly journals Comparison of two methods of femoral tunnel preparation in single-bundle anterior cruciate ligament reconstruction: a prospective randomized study

2012 ◽  
Vol 27 (8) ◽  
pp. 572-576 ◽  
Author(s):  
Qiang Zhang ◽  
Shu Zhang ◽  
Rui Li ◽  
Ya Liu ◽  
Xuecheng Cao
Keyword(s):  
Anterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Single Bundle ◽  
Knee Score ◽  
Lysholm Knee Score ◽  
Anterior Laxity ◽  
Kt 1000 ◽  
Anterior Cruciate

PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM) portal in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT) group (n=38) and anteromedial (AM) group (n=38). Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31) were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.

scholarly journals Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096009
Author(s):  
Etienne Cavaignac ◽  
Timothée Mesnier ◽  
Vincent Marot ◽  
Andrea Fernandez ◽  
Marie Faruch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Widening ◽  
Graft Healing ◽  
Graft Incorporation ◽  
The Mean ◽  
Anterior Cruciate

Background: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group ( P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group ( P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group ( P = .0379). No statistically significant difference was seen between groups in terms of graft healing ( P = .1663). The Lysholm score was statistically higher in the ST4 + LET group ( P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score ( P = .2683) or Tegner score ( P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

scholarly journals Anterior Cruciate Ligament Reconstruction Using an Achilles Tendon Allograft Graft

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Musa Uğur Mermerkaya ◽  
Ahmet Özgür Atay ◽  
Şenol Bekmez ◽  
Fatih Karaaslan ◽  
Erkan Alkan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Achilles Tendon ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Widening ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Femoral Side

Objectives: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop (EndoButton-CL®) on the femoral side, and an IS/staple on the tibial side. Methods: We retrospectively reviewed data on 46 patients who underwent arthroscopic ACL reconstruction with Achilles tendon allografting. Fixation was performed with a bioabsorbable IS (the IS group) in 24 patients (mean age 26.5 years), and with the EndoButton-CL device (the EB group) in 22 patients (mean age 28.1 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. Results: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (p>0.05). Femoral TW at the proximal and middle levels (on both anteroposterior and lateral views) in the IS group was significantly greater than in the EB group (p<0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (p>0.050). Conclusion: Femoral ACL graft fixation using an EndoButton-CL reduced femoral TW compared to use of an IS.

scholarly journals Xenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Willem Van Der Merwe ◽  
Martin Lind ◽  
Peter Faunø ◽  
Kees Van Egmond ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Infection Rate ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Kt 1000 ◽  
Anterior Cruciate

Abstract Purpose To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24-month minimum follow-up. Methods 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow-up was 24-month minimum. Anterior knee stability was measured as KT − 1000 side-to-side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one-legged hop test. Objective manual pivot-shift test and subjective (IKDC, Tegner and SF-36) outcomes were collected. MRI and standard X-Ray were performed. Results 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water-based pathogen graft contamination in processing. Intention-to-treat analysis (using the last observation carried forward imputation method) revealed higher KT − 1000 laxity in xenograft group at 24-month follow-up (P = .042). Also pivot-shift was higher in xenograft group at 12-month (P = .015) and 24-month follow-up (P = .038). Per-protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20–35% as reported in the literature. No immunological reactivity was associated to xenograft group. Conclusions High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction. Level of evidence Multicenter and double-blinded Randomized Controlled Clinical Trial, Level I.

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.

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