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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 quadrant method. The central point of the femoral tunnel was calculated as a/t and b/h. t: the total sagittal diameter of the lateral femoral condyle along Blumensaat's line, a: the distance of the tunnel center from the deepest subchondral contour, h: the maximum intercondylar notch height, b: the distance of the tunnel center from Blumensaat's line.
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Figure 5: Illustration of quadrant method. The central point of the femoral tunnel was calculated as a/t and b/h. t: the total sagittal diameter of the lateral femoral condyle along Blumensaat's line, a: the distance of the tunnel center from the deepest subchondral contour, h: the maximum intercondylar notch height, b: the distance of the tunnel center from Blumensaat's line.

Mentions: According to the quadrant method suggested by Bernard et al.13), the center of the tunnel was defined as point K and a rectangle was formed by the Blumensaat's line, a parallel line tangent to the most inferior margin of the lateral condyle, and two perpendicular lines tangent to the shallowest/deepest subchondral contour of the lateral femoral condyle. Then, the following four distances were measured: the distance of the lateral femoral condyle on the sagittal plane along the Blumensaat's line (t), the maximum height of the intercondylar notch (h), the distance from point K to the deepest subchondral contour of the lateral femoral condyle (a), and the distance from point K to the Blumensaat's line (b). The ratios of a to t and b to h were expressed as percentage (Fig. 5).


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 quadrant method. The central point of the femoral tunnel was calculated as a/t and b/h. t: the total sagittal diameter of the lateral femoral condyle along Blumensaat's line, a: the distance of the tunnel center from the deepest subchondral contour, h: the maximum intercondylar notch height, b: the distance of the tunnel center from Blumensaat's line.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Illustration of quadrant method. The central point of the femoral tunnel was calculated as a/t and b/h. t: the total sagittal diameter of the lateral femoral condyle along Blumensaat's line, a: the distance of the tunnel center from the deepest subchondral contour, h: the maximum intercondylar notch height, b: the distance of the tunnel center from Blumensaat's line.
Mentions: According to the quadrant method suggested by Bernard et al.13), the center of the tunnel was defined as point K and a rectangle was formed by the Blumensaat's line, a parallel line tangent to the most inferior margin of the lateral condyle, and two perpendicular lines tangent to the shallowest/deepest subchondral contour of the lateral femoral condyle. Then, the following four distances were measured: the distance of the lateral femoral condyle on the sagittal plane along the Blumensaat's line (t), the maximum height of the intercondylar notch (h), the distance from point K to the deepest subchondral contour of the lateral femoral condyle (a), and the distance from point K to the Blumensaat's line (b). The ratios of a to t and b to h were expressed as percentage (Fig. 5).

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