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Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study.

Lee KW, Hwang YS, Chi YJ, Yang DS, Kim HY, Choy WS - Knee Surg Relat Res (2014)

Bottom Line: The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin.The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane.In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction.

Materials and methods: The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated.

Results: The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane.

Conclusions: In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate.

No MeSH data available.


Related in: MedlinePlus

Illustration of the method of Tsukada et al.12). The central point of the tibial tunnel from the anterior edge and medial edge of the tibial plateau was calculated as A/B and C/D. A: anterior tangential line, B: lateral tangential line, C: medial tangential line, D: posterior tangential line.
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Figure 4: Illustration of the method of Tsukada et al.12). The central point of the tibial tunnel from the anterior edge and medial edge of the tibial plateau was calculated as A/B and C/D. A: anterior tangential line, B: lateral tangential line, C: medial tangential line, D: posterior tangential line.

Mentions: The tibial tunnel position was evaluated using the method of Tsukada et al.12) A rectangular measurement frame made up of medial tangential line (B), lateral tangential line, anterior tangential line (D), and posterior tangential line of the tibial plateau was drawn. Then, the distances from the center of the tunnel to the anterior tangential line (A) and to the medial tangential line (C) were measured. The ratios of A to B and C to D were expressed as percentage (Fig. 4).


Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study.

Lee KW, Hwang YS, Chi YJ, Yang DS, Kim HY, Choy WS - Knee Surg Relat Res (2014)

Illustration of the method of Tsukada et al.12). The central point of the tibial tunnel from the anterior edge and medial edge of the tibial plateau was calculated as A/B and C/D. A: anterior tangential line, B: lateral tangential line, C: medial tangential line, D: posterior tangential line.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061413&req=5

Figure 4: Illustration of the method of Tsukada et al.12). The central point of the tibial tunnel from the anterior edge and medial edge of the tibial plateau was calculated as A/B and C/D. A: anterior tangential line, B: lateral tangential line, C: medial tangential line, D: posterior tangential line.
Mentions: The tibial tunnel position was evaluated using the method of Tsukada et al.12) A rectangular measurement frame made up of medial tangential line (B), lateral tangential line, anterior tangential line (D), and posterior tangential line of the tibial plateau was drawn. Then, the distances from the center of the tunnel to the anterior tangential line (A) and to the medial tangential line (C) were measured. The ratios of A to B and C to D were expressed as percentage (Fig. 4).

Bottom Line: The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin.The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane.In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction.

Materials and methods: The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated.

Results: The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane.

Conclusions: In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate.

No MeSH data available.


Related in: MedlinePlus