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 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 Clinical study of anatomical ACL reconstruction using a rounded rectangular dilator

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junsuke Nakase ◽  
Yasushi Takata ◽  
Kengo Shimozaki ◽  
Kazuki Asai ◽  
Rikuto Yoshimizu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Clinical Results ◽  
Hamstring Tendon ◽  
Bone Tunnel ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Tunnel Enlargement ◽  
Bone Tunnel Enlargement ◽  
Tibial Translation

Abstract Background The aim of this study was that to compare clinical results between the rounded rectangular femoral tunnel ACL reconstruction (RFTR) and the conventional round femoral tunnel ACL reconstruction using a hamstring tendon. The hypothesis was that ACL reconstruction performed using the rounded rectangular dilator technique was better than that performed using the conventional round femoral tunnel technique in terms of clinical results and bone tunnel enlargement. Methods We conducted retrospective study. After exclusions, 40 patients were included in the conventional anatomical single-bundle ACL reconstruction (ASBR) group and 40 patients were included in the RFTR group. The evaluation items were knee stability, Lysholm knee score, IKDC subjective score at 2 years after surgery and bone tunnel enlargement. Results The RFTR group had a larger femoral tunnel area (average area, 53.1 ± 4.0 mm2 vs. 46.1 ± 7.0 mm2; P < 0.01), better anteroposterior stability, and higher Lysholm scores than the ASBR group (average side-to-side difference for anterior tibial translation, 0.6 ± 0.8 mm vs. 1.6 ± 1.4 mm; P < 0.01; average Lysholm score, 98.5 ± 2.1 vs. 97.5 ± 3.5; P < 0.01). Further, bone tunnel enlargement ratio was significantly lower in the RFTR group (73 ± 38% vs. 107 ± 41%; P < 0.01). Conclusions We designed and developed an original rounded rectangular dilator to perform a novel ACL surgery. This technique can create a larger bone tunnel and improve clinical results than the conventional round anatomical single-bundle ACL reconstruction.

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 Comparison of Clinical Results of Anteromedial and Transtibial Femoral Tunnel Drilling in ACL Reconstruction

2020 ◽  
Author(s):  
Leena Metso ◽  
Kirsi-Maaria Nyrhinen ◽  
Ville Bister ◽  
Jerker Sandelin ◽  
Arsi Harilainen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Rotational Stability ◽  
Tibial Fixation ◽  
Ikdc Score ◽  
Anterior Cruciate

Abstract Background: This study compares long term results of two femoral bone tunnels in anterior cruciate ligament (ACL) reconstruction. The femoral tunnel can be drilled transtibially (TT) or through an anteromedial portal (AM). Methods: 300 patients with ACL reconstructions were chosen for this study. They were divided into two groups: 150 patients with anteromedial drilling (AM) and 150 with transtibial (TT) drilling. In the AM group the reconstructions were performed using semitendinosus graft with Tape Locking Screw (TLS™) technique (n=87) or Retrobutton™ femoral and BioScrew™ tibial fixation with a semitendinosus-gracilis graft (n=63). In the TT group the fixation method used was Rigidfix™ femoral and Intrafix tibial fixation. The evaluation methods were clinical examination, knee scores (Lysholm, Tegner, IKDC) and instrumented laxity measurements (KT-2000™). Our aim was to evaluate if there is a better rotational stability and therefore better clinical results when using AM drilling. Results: In the AM group there were 18 and in the TT group 17 revision procedures which were excluded from the study, leaving 132 patients in the AM group and 133 in the TT group for evaluation. In the one year follow-up there were 90 patients (68,2 %) in the AM group and 86 patients (64,7 %) in the TT group. In the two year follow-up there were 60 (45,5 %) and 58 (43,6 %) patients, respectively. The Tegner activity level was consistently higher in the TT group from preoperatively to two year follow-up postoperatively (p < 0.05). The IKDC score was better at two year follow-up in the TT group (p < 0.05). Statistical analysis was done using the BMDP Statistical Package (Statistical Solutions Ltd, Cork, Ireland). Conclusion: There was a statistically significant difference in IKDC score at two year follow-up, in favor of the TT drilling group compared with the AM group (p < 0.05). No other differences were found between these groups. Both drilling techniques resulted in improved patient performance and patient satisfaction. Also, we found no data supporting the hypothesis that AM drilling technique provides better rotational stability to the knee. Trial registration: ISRCTN16407730 Keywords: Anterior cruciate ligament reconstruction; clinical outcome; anteromedial; transtibial

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]

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