Influence of the different anteromedial portal on femoral tunnel orientation during anatomic ACL reconstruction
Objective: The purpose of this study was to evaluate the effect of femoral tunnel orientation, drilledthrough the accessory anteromedial (AAM) portal or the high AM portal in anatomic anterior cruciateligament (ACL) reconstruction.Methods: In 16 cadaver knees, using o'clock method, centers of the ACL femoral footprint were drilledwith an 8-mm reamer via an AAM portal (eight knees) or a high AM portal (eight knees). Computedtomography (CT) scans were taken of each knee. Three-dimensional (3D) models were constructed toidentify the femoral tunnel orientation and to create femoral tunnel virtual cylinders for measuringtunnel angles and length.Results: In two of the 16 specimens, we observed a posterior femoral cortex blowout (PFCB) whendrilling through a high AM portal. When drilled through the high AM portal, the femoral tunnel lengthwas signiŞcantly shorter than when using an AAM portal (30.3 ± 3.8 mm and 38.2 ± 3.1 mm, p < 0.001).The femoral tunnel length was signiŞcantly shorter in the group with PFCB compared to the group withno PFCB (25.9± 0.6 mm and 35.5 ± 4.5 mm, p ¼ 0.011). The axial obliquity of the high AM portal wassigniŞcantly higher than that of the AAM portal (52.2 ± 5.9and 43.0± 2.3, p¼ 0.003).Conclusions: In anatomic ACL reconstruction, a mal-positioned AM portal can cause abnormal tunnelorientation, which may lead to mechanical failure during ACL reconstruction. Therefore, it is important toselect accurate AM portal positioning, and possibly using an AAM portal by measuring an accurate position when drilling a femoral tunnel in anatomic ACL reconstruction.
___
1. Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH. Indications and contraindications for double-bundle ACL reconstruction. Int Orthop. 2013;37(2): 239e246.2. van Eck CF, Samuelsson K, Vyas SM, van Dijk CN, Karlsson J, Fu FH. Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011;19(Suppl 1):S101eS108.
3. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Jt Surg Br. 2004;86(4):515e520.
4. Getelman MH, Friedman MJ. Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg. 1999;7(3):189e198.
5. Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD. Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res. 1996;(325):100e109.
6. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams 3rd RJ. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy. 2010;26(3):342e350.
7. Xu Y, Ao Y, Wang J, Yu J, Cui G. Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(7):923e932.
8. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P. Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy. 2007;23(1):7e13.
9. Chalmers PN, Mall NA, Cole BJ, Verma NN, Bush-Joseph CA, Bach Jr BR. Anteromedial versus transtibial tunnel drilling in anterior cruciate ligament reconstructions: a systematic review. Arthroscopy. 2013;29(7):1235e1242.
10. Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24(1):113e115.
11. Lubowitz JH. Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy. 2009;25(1):95e101.
12. Chhabra A, Diduch DR, Blessey PB, Miller MD. Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy. 2004;20(3):328e330.
13. Ilahi OA, Ventura NJ, Qadeer AA. Femoral tunnel length: accessory anteromedial portal drilling versus transtibial drilling. Arthroscopy. 2012;28(4): 486e491.
14. Takeda Y, Iwame T, Takasago T, et al. Comparison of tunnel orientation between transtibial and anteromedial portal techniques for anatomic doublebundle anterior cruciate ligament reconstruction using 3-dimensional computed tomography. Arthroscopy. 2013;29(2):195e204.
15. Chang CB, Yoo JH, Chung BJ, Seong SC, Kim TK. Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med. 2010;38(6): 1237e1245.
16. Hamilton SC, Jackson 2nd ER, Karas SG. Anterior cruciate ligament femoral tunnel drilling through anteromedial portal: axial plane drill angle affects tunnel length. Arthroscopy. 2011;27(4):522e525.
17. Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD. The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy. 2007;23(11):1187e1192.
18. Basdekis G, Abisafi C, Christel P. Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Arthroscopy. 2008;24(4):459e464.
19. Zantop T, Haase AK, Fu FH, Petersen W. Potential risk of cartilage damage in double bundle ACL reconstruction: impact of knee flexion angle and portal location on the femoral PL bundle tunnel. Arch Orthop Trauma Surg. 2008;128(5):509e513.
20. Musahl V, Plakseychuk A, VanScyoc A, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med. 2005;33(5): 712e718.
21. Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T. Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med. 2006;34(3):456e463.
22. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35(4):564e574.
23. Lee KW, Hwang YS, Chi YJ, Yang DS, Kim HY, Choy WS. Anatomic single bundle anterior cruciate ligament reconstruction by low accessory anteromedial portal technique: an in vivo 3D CT study. Knee Surg Relat Res. 2014;26(2):97e105.
24. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy. 2003;19(3):297e304.
25. Simmons R, Howell SM, Hull ML. Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Jt Surg Am. 2003;85-A(6):1018e1029.
- ISSN: 1017-995X
- Başlangıç: 2015
- Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
Sayıdaki Diğer Makaleler
Ilhan ALCELİKA, Mark BLOMŞELDA, Cenk OZTÜRKB, Ashish SONİ, Richard CHARİTYC, Alex ACORNLEYC
Giant lipoma extending into two thigh canals: A case report
Melike GÜNGÖR, Emin SIR, Alper AKSOY, Şule AĞIRBAŞ
Platelet rich plasma: Effective treatment for repairing of spinal cord injury in rat
Reza SALARINIA, Hamid Reza SADEGHNIA, Daryoush Hamidi ALAMDARİ, Seyed Javad HOSEİNİ, Asghar MAFİNEZHAD, Mahmoud HOSSEINI
FROM THE EDITOR Dear AOTT Readers
Joan LEAL-BLANQUET, Eduard ALENTORN-GELI, Raúl TORRES-CLARAMUNT, Joan Carles MONLLAU
Jianyin LEİ, Pengfei DONG, Zhiqiang Lİ, Feng ZHU, Zhihua WANG, Xianhua CAİ
Wan-Sun CHOI, Kwang-Hyun LEE, Jin-Sung PARK, Bong Gun LEE
Gun-Woo LEE, Kyung-Soon PARK, Do-Youn KİM, Young-Rok SHİN, Taek-Rim YOON
Relationship between the mobility of medial longitudinal arch and postural control
TANSU BİRİNCİ, FEYZA ŞULE BADILLI DEMİRBAŞ
Emre ACAROĞLU, ÜMİT ÖZGÜR GÜLER, Aysun CETİNYUREK--YAVUZ, SELCEN YÜKSEL, YASEMİN YAVUZ, Selim AYHAN, Montse DOMINGO-SABAT, Ferrán PELLISÉ, Ahmet ALANAY, Francesco S. PEREZ GRUESO, Frank KEİNSTÜCK, Ibrahim OBEID