Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 9, pp 1226–1231 | Cite as

Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study

  • Takanori Iriuchishima
  • Sheila J. M. Ingham
  • Goro Tajima
  • Takashi Horaguchi
  • Akiyoshi Saito
  • Yasuaki Tokuhashi
  • Albert H. Van Houten
  • Maarten M. Aerts
  • Freddie H. FuEmail author
Knee

Abstract

The objective of this study was to investigate the accurate AM and PL tunnel positions in an anatomical double-bundle ACL reconstruction using human cadaver knees with an intact ACL. Fifteen fresh-frozen non-paired adult human knees with a median age of 60 were used. AM and PL bundles were identified by the difference in tension patterns. First, the center of femoral PL and AM bundles were marked with a K-wire and cut from the femoral insertion site. Next, each bundle was divided at the tibial side, and the center of each AM and PL tibial insertion was again marked with a K-wire. Tunnel placement was evaluated using a C-arm radiographic device. For the femoral side assessment, Bernard and Hertel’s technique was used. For the tibial side assessment, Staubli’s technique was used. After radiographic evaluations, all tibias’ soft tissues were removed with a 10% NaOH solution, and tunnel placements were evaluated. In the radiographic evaluation, the center of the femoral AM tunnel was placed at 15% in a shallow–deep direction and at 26% in a high–low direction. The center of the PL bundle was found at 32% in a shallow–deep direction and 52% in a high–low direction. On the tibial side, the center of the AM tunnel was placed at 31% from the anterior edge of the tibia, and the PL tunnel at 50%. The ACL tibial footprint was placed close to the center of the tibia and was oriented sagittally. AM and PL tunnels can be placed in the ACL insertions without any coalition. The native ACL insertion site has morphological variety in both the femoral and tibial sides. This study showed, anatomically and radiologically, the AM and PL tunnel positions in an anatomical ACL reconstruction. We believe that this study will contribute to an accurate tunnel placement during ACL reconstruction surgery and provide reference data for postoperative radiographic evaluation.

Keywords

Anterior cruciate ligament Reconstruction Anatomy Double bundle Tunnel Placement 

References

  1. 1.
    Arnold MP, Kooloos J, Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199PubMedGoogle Scholar
  2. 2.
    Bernard M, Hertel P, Hornung H, Cierpinski TH (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–22PubMedGoogle Scholar
  3. 3.
    Brophy RH, Selby RM, Altchek DW (2006) Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft. Arthroscopy 22:683 e1–5CrossRefPubMedGoogle Scholar
  4. 4.
    Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006CrossRefPubMedGoogle Scholar
  5. 5.
    Colombet P, Robinson J, Christel P et al (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaver study. Arthroscopy 22:984–992CrossRefPubMedGoogle Scholar
  6. 6.
    Darcy SP, Kilger RH, Woo SL, Debski RF (2006) Estimation of ACL forces by reproducing knee kinematics between sets of knees: a novel noninvasive methodology. J Biomech 39:2371–2377CrossRefPubMedGoogle Scholar
  7. 7.
    Doi M, Takahashi M, Abe M, Suzuki D, Nagano A (2009) Lateral radiographic study of the tibial sagittal insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 17:347–351CrossRefPubMedGoogle Scholar
  8. 8.
    Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421CrossRefPubMedGoogle Scholar
  9. 9.
    Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36CrossRefPubMedGoogle Scholar
  10. 10.
    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
  11. 11.
    Fu FH, Shen W, Starman JS, Okeke N, Irrang JJ (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction. A preliminary 2-year prospective study. Am J Sports Med 36:1263–1274CrossRefPubMedGoogle Scholar
  12. 12.
    Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23:7–13CrossRefPubMedGoogle Scholar
  13. 13.
    Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472CrossRefPubMedGoogle Scholar
  14. 14.
    Iriuchishima T, Tajima G, Ingham SJ et al (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594CrossRefPubMedGoogle Scholar
  15. 15.
    Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304CrossRefPubMedGoogle Scholar
  16. 16.
    Luites JW, Wymenga AB, Blankevoort L, Kooloos JG (2007) Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 15:1422–1431CrossRefPubMedGoogle Scholar
  17. 17.
    Mae T, Shino K, Miyama T et al (2001) Single versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716CrossRefPubMedGoogle Scholar
  18. 18.
    Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628CrossRefPubMedGoogle Scholar
  19. 19.
    Neven E, D’Hooghe P, Bellemans J (2008) Double-bundle anterior cruciate ligament reconstruction: a cadaveric study on the posterolateral tunnel position and safety of the lateral structures. Arthroscopy 24:436–440CrossRefPubMedGoogle Scholar
  20. 20.
    Purnell ML, Larson AI, Clancy W (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
  21. 21.
    Siebold R, Ellert T, Metz S, Metz J (2008) Tibial Insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161CrossRefPubMedGoogle Scholar
  22. 22.
    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
  23. 23.
    Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position, anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146CrossRefPubMedGoogle Scholar
  24. 24.
    Steckel H, Fu FH, Baums MH, Klinger HM (2009) Arthroscopic evaluation of the ACL double bundle structure. Knee Surg Sports Traumatol Arthrosc 17:782–785CrossRefPubMedGoogle Scholar
  25. 25.
    Steckel H, Starman JS, Baums MH, Klinger HM, Schultz W, Fu FH (2007) Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports 17:387–392PubMedGoogle Scholar
  26. 26.
    Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189CrossRefPubMedGoogle Scholar
  27. 27.
    Tajima G, Nozaki M, Iriuchishima T et al (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866CrossRefPubMedGoogle Scholar
  28. 28.
    Tallay A, Lim MH, Bartlett J (2008) Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint. Knee Surg Sports Traumatol Arthrosc 16:741–746CrossRefPubMedGoogle Scholar
  29. 29.
    Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129CrossRefPubMedGoogle Scholar
  30. 30.
    Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMedGoogle Scholar
  31. 31.
    Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251CrossRefPubMedGoogle Scholar
  32. 32.
    Zantop T, Wellmann M, Fu FH, Peterson W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Takanori Iriuchishima
    • 1
    • 2
  • Sheila J. M. Ingham
    • 1
  • Goro Tajima
    • 1
  • Takashi Horaguchi
    • 2
  • Akiyoshi Saito
    • 2
  • Yasuaki Tokuhashi
    • 2
  • Albert H. Van Houten
    • 1
  • Maarten M. Aerts
    • 1
  • Freddie H. Fu
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Department of Orthopaedic SurgeryNihon University School of MedicineTokyoJapan

Personalised recommendations