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Avoiding Complications and Technical Variability During Arthroscopically Assisted Transtibial ACL Reconstructions by Using a C-Arm With Image Intensifier.

Trentacosta N, Fillar AL, Liefeld CP, Hossack MD, Levy IM - Orthop J Sports Med (2014)

Bottom Line: There were no instances of graft-tunnel mismatch.The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle.Incremental adjustment was essential to accomplish this.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.

ABSTRACT

Background: Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction.

Purpose: To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone-patellar tendon-bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels.

Study design: Case series; Level of evidence, 4.

Methods: A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone-patellar tendon-bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded.

Results: There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely.

Conclusion: The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications.

Clinical relevance: The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon's preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery.

No MeSH data available.


Related in: MedlinePlus

Correlation of (A) graft length, (B) Blumensaat length, and (C) tibial α angle with patient height in the study population.
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fig9-2325967114530075: Correlation of (A) graft length, (B) Blumensaat length, and (C) tibial α angle with patient height in the study population.

Mentions: The average tibial α angle for our surgical population was 59.59° (range, 39.7°-76.8°; SD, 6.84°) (Figure 8). None of the relationships between patient height and graft length, patient height and Blumensaat length, or patient height and importantly, tibial α angle, accounted for more than 22% predictability (Figure 9, A-C).


Avoiding Complications and Technical Variability During Arthroscopically Assisted Transtibial ACL Reconstructions by Using a C-Arm With Image Intensifier.

Trentacosta N, Fillar AL, Liefeld CP, Hossack MD, Levy IM - Orthop J Sports Med (2014)

Correlation of (A) graft length, (B) Blumensaat length, and (C) tibial α angle with patient height in the study population.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555598&req=5

fig9-2325967114530075: Correlation of (A) graft length, (B) Blumensaat length, and (C) tibial α angle with patient height in the study population.
Mentions: The average tibial α angle for our surgical population was 59.59° (range, 39.7°-76.8°; SD, 6.84°) (Figure 8). None of the relationships between patient height and graft length, patient height and Blumensaat length, or patient height and importantly, tibial α angle, accounted for more than 22% predictability (Figure 9, A-C).

Bottom Line: There were no instances of graft-tunnel mismatch.The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle.Incremental adjustment was essential to accomplish this.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.

ABSTRACT

Background: Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction.

Purpose: To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone-patellar tendon-bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels.

Study design: Case series; Level of evidence, 4.

Methods: A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone-patellar tendon-bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded.

Results: There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely.

Conclusion: The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications.

Clinical relevance: The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon's preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery.

No MeSH data available.


Related in: MedlinePlus