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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 9, pp 1164–1168 | Cite as

The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction

  • Konsei ShinoEmail author
  • Tomoyuki Suzuki
  • Takehiko Iwahashi
  • Tatsuo Mae
  • Norimasa Nakamura
  • Ken Nakata
  • Shigeto Nakagawa
Knee

Abstract

The purposes of this study were to establish the technique to arthroscopically identify the resident’s ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 × 10 mm was created just behind the ridge. At 3–4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7–10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident’s ridge. The resident’s ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction.

Keywords

Arthroscopic ACL reconstruction Anatomical femoral tunnel Resident’s ridge Notchplasty Radiofrequency energy Three-dimensional computed tomography 

Supplementary material

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References

  1. 1.
    Amis AA, Jacob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthosc 6:S2–S12CrossRefGoogle Scholar
  2. 2.
    Arnold MP, Kooloos J, van Kampen A (2001) Single-incision misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthosc 9:194–199Google Scholar
  3. 3.
    Colombet P, Robinson J, Christel P, Franceschi J-P, Dijan P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomical reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992CrossRefPubMedGoogle Scholar
  4. 4.
    Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthosc 17:220–227CrossRefGoogle Scholar
  5. 5.
    Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225CrossRefPubMedGoogle Scholar
  6. 6.
    Giron F, Cuomo P, Aglietti P, Bull AMJ, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthosc 14:250–256CrossRefGoogle Scholar
  7. 7.
    Hame SL, Markolf KL, Hunter M, Oakes D, Zoric B (2003) Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Arthroscopy 19:340–345CrossRefPubMedGoogle Scholar
  8. 8.
    Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19:931–935CrossRefPubMedGoogle Scholar
  9. 9.
    Mae T, Shino K, Matsumoto N, Hamada M, Nakata K (2007) Two-bundle ACL reconstruction using autogenous hamstring tendons—anatomical twin tunnel vs. Rosenberg’s bi-socket procedure: a biomechanical comparison in laxity match pretension. Knee Surg Sports Traumatol Arthosc 15:328–334CrossRefGoogle Scholar
  10. 10.
    Markolf KL, Hame JF, Hunter M, Oakes D, Gause P (2002) Biomechanical effects of femoral notchplasty in anterior cruciate ligament reconstruction. Am J Sports Med 30:83–89PubMedGoogle Scholar
  11. 11.
    Purnell ML, Larson AI, Clancy WG (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36:2083–2090CrossRefPubMedGoogle Scholar
  12. 12.
    Shino K, Horibe S, Hamada M, Nakamura N, Nakata K, Mae T, Toritsuka Y (2002) Allograft anterior cruciate ligament reconstruction. Tech Knee Surg 1:78–85Google Scholar
  13. 13.
    Shino K, Nakata K, Nakamura N, Mae T, Ohtsubo H, Iwahashi T, Nakagawa S (2005) Anatomical ACL reconstruction using two double-looped hamstring tendon grafts via twin femoral and triple tibial tunnels. Oper Tech Orthop 15:130–134CrossRefGoogle Scholar
  14. 14.
    Shino K, Nakata K, Horibe S, Nakamura N, Toritsuka Y, Nakagawa S, Suzuki T (2008) Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft to mimic natural fiber arrangement. Arthroscopy 24:1178–1183CrossRefPubMedGoogle Scholar
  15. 15.
    Siebold R, Ellert T, Metz S, Metz J (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy 24:585–592CrossRefPubMedGoogle Scholar
  16. 16.
    Steckel H, Musahl V, Fu FH (2009) The femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: a radiographic evaluation. Knee Surg Sports Traumatol Arthosc, (in press) published online. doi: 10.1007/s00167-009-0852-7
  17. 17.
    Takahashi T, Takeda H, Watanabe S, Yamamoto H (2009) Laser-guided placement of the tibial guide in the transtibial technique for anterior cruciate ligament reconstruction. Arthroscopy 25:212–214CrossRefPubMedGoogle Scholar
  18. 18.
    Weiler A, Scheffler S, Apreleva M (2005) Healing of ligament and tendon to bone. In: Walsh WR (ed) Orthopaedic biology and medicine: repair and regeneration of ligaments, tendons, and joint capsule. Humana Press, Totowa, pp 201–231Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Konsei Shino
    • 1
    Email author
  • Tomoyuki Suzuki
    • 2
  • Takehiko Iwahashi
    • 2
  • Tatsuo Mae
    • 2
  • Norimasa Nakamura
    • 2
  • Ken Nakata
    • 2
  • Shigeto Nakagawa
    • 3
  1. 1.Faculty of Comprehensive RehabilitationOsaka Prefecture UniversityHabikinoJapan
  2. 2.Department of OrthopaedicsOsaka University Medical SchoolSuitaJapan
  3. 3.Department of Sports OrthopaedicsYukioka HospitalKita-ku, OsakaJapan

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