J arch: A contemporary soft-tissue landmark for anatomic placement of femoral tunnel in remnant-preserving anterior cruciate ligament (ACL) reconstruction

Objectives: Femoral tunnel placement is a critical step in ACL reconstruction surgery. Surgeons usually end up clearing the soft tissue to access the bony landmarks. Biological ACL reconstruction with preservation of soft tissue can be done with reliable soft tissue landmarks. Our objective is to assess the reliability of a soft tissue landmark- femoral ACL remnant, for appropriate femoral tunnel placement in soft tissue preserving ACL reconstruction. Materials and Methods: This study was a retrospective analysis of prospectively collected data of 40 consecutive patients who underwent primary ACL reconstruction in January 2018 by a single surgeon. An inverse J shaped tissue arch was identified and used as soft tissue landmark for anatomic placement of femoral tunnel. This arch was a part of femoral ACL remnant. MRI films were examined post-operatively to determine the position of the femoral tunnel. Postoperatively, MRI of these patients were reviewed to evaluate the femoral tunnel position in terms of depth and height from the proximal condylar surface and notch roof, respectively. Results: The center of the femoral tunnel was found to be at a mean depth of 27.12 ± 2.2% from the proximal condylar surface (parallel to Blumensaat’s line) and a mean height of 30.96 ± 2.75% from the notch roof (perpendicular to Blumensaat’s line), which is at par with previously defined data given by various studies. Conclusion: J arch can be used as a dependable soft tissue landmark and a guide for the anatomic placement of femoral tunnel in biological ACL Reconstruction.

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Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

The Open Orthopaedics Journal ◽

10.2174/1874325001610010481 ◽

2016 ◽

Vol 10 (1) ◽

pp. 481-489 ◽

Cited By ~ 7

Author(s):

Erhan Sukur ◽

, Yunus Emre Akman ◽

, Ahmet Senel ◽

, Ethem Ayhan Unkar ◽

, Huseyin Nevzat Topcu ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Single Bundle ◽

Functional Evaluation ◽

Tunnel Placement ◽

Normal Life ◽

Anterior Cruciate ◽

Femoral Tunnel Placement

Background: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. Objective: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. Methods: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. Results: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. Conclusion: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up.

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