DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192679

How anatomical is our tunnel? A three dimensional CT evaluation of femoral tunnel in anatomic anteromedial single bundle anterior cruciate ligament reconstruction

Saurabh Dutt, Vinod Kumar

Abstract


Background: ACL reconstruction has become a common orthopaedic procedure. The anatomy and biomechanics of ACL have been one of the most researched and debated topics in the orthopaedic literature. This has implication on the surgical procedure too with shift from traditional transtibial to more anatomic anteromedial ACL reconstruction. Anteromedial technique results in more anatomic femoral tunnel with graft positioned at the native insertion site. The tunnel position is crucial for better outcome after ACL reconstruction. The purpose of the study was to ascertain the femoral tunnel position made by anatomic single bundle reconstruction with the help of three dimensional computer tomography.

Methods: A prospective case series involving thirty patients with ACL tear who underwent anteromedial single bundle ACL reconstruction. Computer tomography scans were performed on thirty knees that underwent single bundle anteromedial ACL reconstruction. Three dimensional models were created and the data was analyzed according to coordinate system method. Femoral tunnel position was measured in proximal to distal and posterior to anterior directions. This data was compared with the already published reference data on anatomical tunnel position.

Results: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.

Conclusions: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.


Keywords


Anterior cruciate ligament reconstruction technique, Anatomical, Femoral tunnel, Computed tomography, Three dimensional reconstruction, Co-Ordinate axes method

Full Text:

PDF

References


Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R. ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res. 2007;458:180-7.

Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med.2005;33:335-46.

Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am. 2010;92:1427-31.

Tashman S, Kolowich P, Collon D, Anderson K, Anderst W. Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res. 2007;454:66-73.

Bedi A, Altchek DW. The Footprint anterior cruciate ligament technique: An anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy. 2009;25:1128-38.

Jepsen CF, Lundberg-Jensen AK, Faunoe P. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy. 2007;23:1326-33.

Forsythe B, Kopf S, Wong AK, Martins CAQ, Anderst W, Tashman S, et al. The location of femoral and tibial tunnels of anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am. 2010;92:1418-26.

Karlsson J. Anatomy is the key. Knee Surg Sports Traumatol Arthrosc. 2010;18:1.

Pombo MW, Shen W, Fu FH. Anatomic double bundle anterior cruciate ligament reconstruction: Where are we today? Arthroscopy. 2008;24:1168-77.

Jarvela T. Double bundle versus single bundle anterior cruciate ligament reconstruction: A prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc. 2007;15:500-7.

Zantop T, Diermann N, Schumacher T, Schranz S, Fu FH, Petersen W. Anatomical and anatomical double bundle anterior cruciate ligament reconstruction: Importance of femoral tunnel location on knee kinematics. Am J Sports Med. 2008;36:678-85.

Harner CD, Poehling G. Double bundle or double trouble? Arthroscopy. 2004;20:1013–4.

Markolf KL, Park S, Jackson SR, McAllister DR. Anterior- posterior and rotatory stability of single and double bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am. 2009;91:107-18.

Bird JH, Carmont MR, Dhillon M, Smith N, Brown C, Thompson P, et al. Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy. 2011;27:1259-67.