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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 9, pp 1245–1251 | Cite as

Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction

  • Alcindo Silva
  • Ricardo Sampaio
  • Elisabete Pinto
Knee

Abstract

Two different approaches for drilling the femoral tunnel are commonly used in single-bundle anterior cruciate ligament (ACL) reconstruction: creating the femoral tunnel through the tibial tunnel or drilling the tunnel through a low anteromedial arthroscopy portal. When using a transtibial drilling technique, the location of the femoral tunnel is restricted by the angulation of the tibial tunnel in the coronal plane and may lead to a high placement of the femoral tunnel in the intercondylar notch. However, some authors refer that the femoral tunnel can be positioned correctly in the center of the femoral ACL footprint by means of a transtibial technique if the tibial tunnel forms an angle between 60° and 65° to the medial joint line of the tibia in the coronal plane. The purpose of this study was to evaluate prospectively with CT scans whether a femoral tunnel drilled through a tibial tunnel at an angle of 60°–65° in the coronal plane is created between the AM and PL bundles in the lateral femoral condyle. Our results showed that the median difference of the distance between the center of the femoral tunnel and the center of the AM and PL bundles along the Blumensaat’s line was 6 and 5%, respectively. In the height of the femoral condyle, the median difference of the distance between the center of the femoral tunnel and the center of the AM and PL bundles was 0 and 31%, respectively. In conclusion, when drilling the femoral tunnel via a transtibial technique with the tibial tunnel angled 60°–65° in the coronal plane, the center of the femoral tunnel is created in the AM bundle footprint in the height of the femoral condyle.

Keywords

Anterior cruciate ligament reconstruction Single bundle Tunnel placement Transtibial drilling 

References

  1. 1.
    Aglietti P, Zaccherotti G, Menchetti PP, De Biase P (1995) A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 3:2–8CrossRefPubMedGoogle Scholar
  2. 2.
    Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2009) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-009-0964-0
  3. 3.
    Arnold MP, Kooloos J, van 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
  4. 4.
    Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602–609CrossRefPubMedGoogle Scholar
  5. 5.
    Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–21PubMedGoogle Scholar
  6. 6.
    Ferretti A, Monaco E, Labianca L, De Carli A, Maestri B, Conteduca F (2009) Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation. Am J Sports Med 37:1548–1553CrossRefPubMedGoogle Scholar
  7. 7.
    Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Trauma Surg 124:281–284CrossRefPubMedGoogle Scholar
  8. 8.
    Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15:364–367CrossRefPubMedGoogle Scholar
  9. 9.
    Gougoulias N, Khanna A, Griffiths D, Maffulli N (2008) ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 15:486–490CrossRefPubMedGoogle Scholar
  10. 10.
    Grontvedt T, Pena F, Engebretsen L (1996) Accuracy of femoral Tunnel placement and resulting graft force using one or two incision drill guides. A cadaver study on ten paired knees. Arthroscopy 12:187–192CrossRefPubMedGoogle Scholar
  11. 11.
    Hantes ME, Dailiana Z, Zachos VC, Varitimidis SE (2006) Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 14:497–501CrossRefPubMedGoogle Scholar
  12. 12.
    Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35:1708–1715CrossRefPubMedGoogle 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.
    Howell SM, Hull ML (2009) Checkpoints for judging tunnel and anterior cruciate ligament graft placement. J Knee Surg 22:161–170CrossRefPubMedGoogle Scholar
  15. 15.
    Iriuchishima T, Tajima G, Ingham SJ, Shen W, Horaguchi T, Saito A, Smolinski P, Fu FH (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594CrossRefPubMedGoogle Scholar
  16. 16.
    Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913CrossRefPubMedGoogle Scholar
  17. 17.
    Kohn D, Busche T, Carls J (1998) Drill hole position in endoscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:S13–S15CrossRefPubMedGoogle Scholar
  18. 18.
    Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL-Y (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
  19. 19.
    Lopez-Vidriero E, Johnson D (2009) Evolving concepts in tunnel placement. Sports Med Arthrosc Rev 17:210–216CrossRefGoogle Scholar
  20. 20.
    Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101CrossRefPubMedGoogle Scholar
  21. 21.
    Nishimoto K, Kuroda R, Mizuno K, Hoshino Y, Nagamune K, Kubo S, Yagi M, Yamaguchi M, Yoshiya S, Kurosaka M (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 17:270–276CrossRefPubMedGoogle Scholar
  22. 22.
    Noh HK, Wang JH, Bada LP, Ahn JH, Yoo JC, Nha KW, Lee YS (2008) Transtibial anterior cruciate ligament double bundle reconstruction technique: two tibial bundle in one tibial tunnel. Arch Orthop Trauma Surg 128:1245–1250CrossRefPubMedGoogle Scholar
  23. 23.
    Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47CrossRefPubMedGoogle Scholar
  24. 24.
    Sastre S, Popescu D, Núñez M, Pomes J, Tomas X, Peidro L (2009) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18:32–36CrossRefPubMedGoogle Scholar
  25. 25.
    Scopp J, Jasper L, Belkoff S, Moorman C (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20:294–299CrossRefPubMedGoogle Scholar
  26. 26.
    Simmons R, Howell SM, Hull ML (2003) 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 Joint Surg Am 85:1018–1029PubMedGoogle Scholar
  27. 27.
    Sommer C, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8:207–213CrossRefPubMedGoogle Scholar
  28. 28.
    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
  29. 29.
    Steiner ME (2008) Evaluation and management of ACL injuries. In: McKeon B, Bono J, Richmond J (eds) Knee arthroscopy. Springer, New YorkGoogle Scholar
  30. 30.
    Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792CrossRefPubMedGoogle Scholar
  31. 31.
    Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992CrossRefPubMedGoogle Scholar
  32. 32.
    Zantop T, Wellmann M, Fu FH, Petersen 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

  • Alcindo Silva
    • 1
  • Ricardo Sampaio
    • 1
  • Elisabete Pinto
    • 1
    • 2
  1. 1.Hospital Militar D. Pedro VPortoPortugal
  2. 2.Department of Hygiene and EpidemiologyMedical School of University of PortoPortoPortugal

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