scholarly journals The Relationship Between Lateral Femoral Anatomic Structures and the Femoral Tunnel Outlet in Anterior Cruciate Ligament Reconstruction Using the Transportal Technique: A 3-Dimensional Simulation Analysis

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095278
Author(s):  
Kwangho Chung ◽  
Chong Hyuk Choi ◽  
Sung-Hwan Kim ◽  
Sung-Jae Kim ◽  
Woosung Do ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Tunnel Length ◽  
Tunnel Wall ◽  
Lateral Epicondyle ◽  
3 Dimensional ◽  
Anterior Cruciate ◽  
The Relationship

Background: The relationship between the lateral femoral anatomic structures and femoral tunnel outlet according to changes in knee flexion and transverse drill angle during femoral tunnel creation in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To investigate the relationships between the lateral femoral anatomic structures and femoral tunnel outlet according to various knee flexion and transverse drill angles and to determine appropriate angles at which to minimize possible damage to the lateral femoral anatomic structures. Study Design: Controlled laboratory study. Methods: Simulation of ACL reconstruction was conducted using a 3-dimensional reconstructed knee model from the knees of 30 patients. Femoral tunnels were created using combinations of 4 knee flexion and 3 transverse drill angles. Distances between the femoral tunnel outlet and lateral femoral anatomic structures (minimum safe distance, 12 mm), tunnel length, and tunnel wall breakage were assessed. Results: Knee flexion and transverse drill angles independently affected distances between the femoral tunnel outlet and lateral femoral anatomic structures. As knee flexion angle increased, the distance to the lateral collateral ligament, lateral epicondyle, and popliteal tendon decreased, whereas the distance to the lateral head of the gastrocnemius increased ( P < .001). As the transverse drill angle decreased, distances to all lateral femoral anatomic structures increased ( P < .001). Considering safe distance, 120°, 130°, or 140° of knee flexion and maximum transverse drill angle (MTA) could damage the lateral collateral ligament; 130° or 140° of knee flexion and MTA could damage the lateral epicondyle; and 110° or 120° of knee flexion and MTA could damage the lateral head of the gastrocnemius. Tunnel wall breakage occurred under the conditions of MTA – 10° or MTA – 20° with 110° of knee flexion and MTA – 20° with 120° of knee flexion. Conclusion: Approximately 120° of knee flexion with MTA – 10° and 130° or 140° of knee flexion with MTA – 20° or MTA – 10° could be recommended to prevent damage to the lateral femoral anatomic structures, secure adequate tunnel length, and avoid tunnel wall breakage. Clinical Relevance: Knee flexion angle and transverse drill angle may affect femoral tunnel creation, but thorough studies are lacking. Our findings may help surgeons obtain a stable femoral tunnel while preventing damage to the lateral femoral anatomic structures.

scholarly journals Anterior cruciate ligament femoral-tunnel drilling through an anteromedial portal: 3-dimensional plane drilling angle affects tunnel length relative to notchplasty

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Dong-Kyu Moon ◽  
Ho-Seung Jo ◽  
Dong-Yeong Lee ◽  
Dong-Geun Kang ◽  
Hee-Chan Won ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sagittal Plane ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Standard Technique ◽  
Axial Plane ◽  
Coronal Plane ◽  
Tunnel Length ◽  
3 Dimensional ◽  
Anterior Cruciate

Abstract Background Notchplasty is a surgical technique often performed during anterior cruciate ligament reconstruction (ACLR) with widening of the intercondylar notch of the lateral distal femur to avoid graft impingement. The purpose of this study was to correlate femoral-tunnel length with 3-dimensional (3D) drilling angle through the anteromedial (AM) portal with and without notchplasty. Materials and methods Computer data were collected from an anatomical study using 16 cadaveric knees. The anterior cruciate ligament (ACL) femoral insertion was dissected and outlined for gross anatomical observation. The dissected cadaveric knees were scanned by computed tomography (CT). Three-dimensional measurements were calculated using software (Geomagic, Inc., Research Triangle Park, NC, USA) and included the center of the ACL footprint and the size of the ACL femoral footprint. The femoral-tunnel aperture centers were measured in the anatomical posterior-to-anterior and proximal-to-distal directions using Bernard’s quadrant method. The ACL tunnel was created 3-demensionally in the anatomical center of femoral foot print of ACL using software (SolidWorks®, Corp., Waltham, MA, USA). The 8-mm cylinder shaped ACL tunnel was rested upon the anatomical center of the ACL footprint and placed in three different positions: the coronal plane, the sagittal plane, and the axial plane. Finally, the effect of notchplasty on the femoral-tunnel length and center of the ACL footprint were measured. All the above-mentioned studies performed ACLR using the AM portal. Results The length of the femoral tunnels produced using the low coronal and high axial angles with 5-mm notchplasty became significantly shorter as the femoral starting position became more horizontal. The result was 30.38 ± 2.11 mm on average at 20° in the coronal plane/70° in the axial plane/45° in the sagittal plane and 31.26 ± 2.08 mm at 30° in the coronal plane/60° in the axial plane/45° in the sagittal plane, respectively, comparing the standard technique of 45° in the coronal/45° in the axial/45° in the sagittal plane of 32.98 ± 3.04 mm (P < 0.001). The tunnels made using the high coronal and low axial angles with notchplasty became longer than those made using the standard technique: 40.31 ± 3.36 mm at 60° in the coronal plane/30° in the axial plane/45° in the sagittal plane and 50.46 ± 3.13 mm at 75° in the coronal plane/15° in the axial plane/45° in the sagittal plane (P < 0.001). Conclusions Our results show that excessive notchplasty causes the femoral tunnel to be located in the non-anatomical center of the ACL footprint and reduces the femoral-tunnel length. Therefore, care should be taken to avoid excessive notchplasty when performing this operation.

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.

scholarly journals The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction

2017 ◽  
Vol 18 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Luiz Gabriel Betoni Guglielmetti ◽  
Leandro Girardi Shimba ◽  
Leonardo Cantarelli do Santos ◽  
Fabrício Roberto Severino ◽  
Nilson Roberto Severino ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Length ◽  
Cruciate Ligament Reconstruction ◽  
Graft Rupture ◽  
Anterior Cruciate

scholarly journals Biomechanical Effects of Aspect Ratio of the Knee during Outside-In Anterior Cruciate Ligament Reconstruction Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Tae Soo Bae ◽  
Byeong Chan Cho ◽  
Dai-Soon Kwak
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Maximum Stress ◽  
Cruciate Ligament ◽  
Tunnel Length ◽  
Bending Angle ◽  
Lateral Epicondyle ◽  
Cruciate Ligament Reconstruction ◽  
Graft Bending Angle ◽  
Anterior Cruciate

We analyzed tunnel length, graft bending angle, and stress of the graft according to tunnel entry position and aspect ratio (ASR: ratio of anteroposterior depth to mediolateral width) of the articular surface for the distal femur during single-bundle outside-in anterior cruciate ligament reconstruction (ACLR) surgery. We performed multiflexible body dynamic analyses with four ASR (98, 105, 111, and 117%) knee models. The various ASRs were associated with approximately 1 mm changes in tunnel length. The graft bending angle increased when the entry point was far from the lateral epicondyle and was larger when the ASR was smaller. The graft was at maximum stress, 117% ASR, when the tunnel entry point was near the lateral epicondyle. The maximum stress value at a 5 mm distance from the lateral epicondyle was 3.5 times higher than the 15 mm entry position, and the cases set to 111% and 105% ASR showed 1.9 times higher stress values when at a 5 mm distance compared with a 15 mm distance. In the case set at 98% ASR, the low-stress value showed a without-distance difference from the lateral epicondyle. Our results suggest that there is no relationship between the ASR and femoral tunnel length. A smaller ASR causes a higher graft bending angle, and a larger ASR causes greater stress in the graft.

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