Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 9, pp 2194–2201 | Cite as

Clinical outcome of anatomic double-bundle ACL reconstruction and 3D CT model-based validation of femoral socket aperture position

  • Shuji TaketomiEmail author
  • Hiroshi Inui
  • Kensuke Nakamura
  • Jinso Hirota
  • Takaki Sanada
  • Hironari Masuda
  • Hideki Takeda
  • Sakae Tanaka
  • Takumi Nakagawa
Knee

Abstract

Purpose

The purpose of this study was to evaluate the clinical results of anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction in which anatomic position of femoral socket apertures was validated using three-dimensional (3D) computed tomography (CT) modelling.

Methods

Anatomic DB ACL reconstructions with hamstring autografts were performed in 34 patients. Two femoral sockets were created through a far anteromedial (AM) portal behind the lateral intercondylar ridge with the assistance of intraoperative 3D fluoroscopic navigation. Femoral tunnel aperture positioning was investigated postoperatively using 3D CT images in all patients. Clinical results were also evaluated subjectively and objectively at least up to 2 years.

Results

Measurement of the AM and the posterolateral (PL) femoral socket locations on the 3D CT images using the quadrant method showed that the centre of the AM socket aperture was located at a depth of 21.0 ± 4.1 % and a height of 30.5 ± 9.3 % and that of the PL socket aperture was located at a depth of 31.3 ± 5.8 % and a height of 57.2 ± 7.7 %. The femoral socket locations were considered as anatomic in accordance with previous cadaveric studies examining the positions of ACL femoral insertion site. Subjectively, the mean Lysholm score was 96.9 ± 4.0 points. According to IKDC final objective scores, 26 knees (76 %) were objectively graded as normal, 8 (24 %) as nearly normal, and 0 (0 %) as abnormal or severely abnormal. Postoperative side-to-side anterior translation measured with a KT-2000 arthrometer averaged 0.7 ± 1.2 mm.

Conclusions

DB ACL reconstructions in which femoral socket apertures were validated anatomically using 3D CT provided satisfactory short-term results.

Level of evidence

Case series, Level IV.

Keywords

Navigation Femoral tunnel Anterior cruciate ligament reconstruction Three-dimensional computed tomography Double-bundle Anatomic 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113PubMedCrossRefGoogle Scholar
  2. 2.
    Amis A, Dawkins G (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267PubMedGoogle Scholar
  3. 3.
    Arnoczky S (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 172:19–25PubMedGoogle Scholar
  4. 4.
    Basdekis G, Christel P, Anne F (2009) Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan. Knee Surg Sports Traumatol Arthrosc 17:1089–1094PubMedCrossRefGoogle 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.
    Bird JH, Carmont MR, Dhillon M, Smith N, Brown C, Thompson P, Spalding T (2011) Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 27:1259–1267PubMedCrossRefGoogle Scholar
  7. 7.
    Colombet P, Robinson J (2008) Computer-assisted, anatomic, double-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:1152–1160PubMedCrossRefGoogle Scholar
  8. 8.
    Colombet P, Robinson J, Christel P, Franceschi J, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRefGoogle Scholar
  9. 9.
    Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH (2012) Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Knee Surg Sports Traumatol Arthrosc 20:62–68PubMedCrossRefGoogle Scholar
  10. 10.
    Ferretti M, Ekdahl M, Shen W, Fu F (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRefGoogle Scholar
  11. 11.
    Forsythe B, Kopf S, Wong A, Martins C, Anderst W, Tashman S, Fu F (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426PubMedCrossRefGoogle Scholar
  12. 12.
    Fu F, Jordan S (2007) The lateral intercondylar ridge—a key to anatomic anterior cruciate ligament reconstruction. J Bone Joint Surg Am 89:2103–2104PubMedCrossRefGoogle Scholar
  13. 13.
    Galway H, MacIntosh D (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50PubMedGoogle Scholar
  14. 14.
    Giron F, Cuomo P, Aglietti P, Bull A, Amis A (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256PubMedCrossRefGoogle Scholar
  15. 15.
    Hoser C, Tecklenburg K, Kuenzel KH, Fink C (2005) Postoperative evaluation of femoral tunnel position in ACL reconstruction: plain radiography versus computed tomography. Knee Surg Sports Traumatol Arthrosc 13:256–262PubMedCrossRefGoogle Scholar
  16. 16.
    Iriuchishima T, Ingham SJ, Tajima G, Horaguchi T, Saito A, Tokuhashi Y, Van Houten AH, Aerts MM, Fu FH (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231PubMedCrossRefGoogle Scholar
  17. 17.
    Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P, Richmond J, Shelborne K (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMedGoogle Scholar
  18. 18.
    Kawakami Y, Hiranaka T, Matsumoto T, Hida Y, Fukui T, Uemoto H, Doita M, Tsuji M, Kurosaka M, Kuroda R (2012) The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1503–1510PubMedCrossRefGoogle Scholar
  19. 19.
    Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687PubMedCrossRefGoogle Scholar
  20. 20.
    Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20:2200–2207PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Lee YS, Sim JA, Kwak JH, Nam SW, Kim KH, Lee BK (2012) Comparative analysis of femoral tunnels between outside-in and transtibial double-bundle anterior cruciate ligament reconstruction: a 3-dimensional computed tomography study. Arthroscopy 28:1417–1423PubMedCrossRefGoogle Scholar
  22. 22.
    Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27:391–398PubMedCrossRefGoogle Scholar
  23. 23.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRefGoogle Scholar
  24. 24.
    Muneta T, Koga H, Mochizuki T, Ju Y, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628PubMedCrossRefGoogle Scholar
  25. 25.
    Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718PubMedCrossRefGoogle Scholar
  26. 26.
    Nakagawa T, Takeda H, Nakajima K, Nakayama S, Fukai A, Kachi Y, Kawano H, Miura T, Nakamura K (2008) Intraoperative 3-dimensional imaging-based navigation-assisted anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:1161–1167PubMedCrossRefGoogle Scholar
  27. 27.
    Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240PubMedCrossRefGoogle Scholar
  28. 28.
    Papannagari R, Gill T, Defrate L, Moses J, Petruska A, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012PubMedCrossRefGoogle Scholar
  29. 29.
    Sadoghi P, Kropfl A, Jansson V, Muller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27:355–364PubMedCrossRefGoogle Scholar
  30. 30.
    Shino K, Horibe S, Hamada M, Nakamura N, Nakata K, Toritsuka Y, Mae T (2002) Allograft anterior cruciate ligament reconstruction. Tech Knee Surg 1:78–85CrossRefGoogle Scholar
  31. 31.
    Shino K, Suzuki T, Iwahashi T, Mae T, Nakamura N, Nakata K, Nakagawa S (2010) The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1164–1168PubMedCrossRefGoogle Scholar
  32. 32.
    Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145PubMedCrossRefGoogle Scholar
  33. 33.
    Taketomi S, Inui H, Nakamura K, Hirota J, Takei S, Takeda H, Tanaka S, Nakagawa T (2012) Three-dimensional fluoroscopic navigation guidance for femoral tunnel creation in revision anterior cruciate ligament reconstruction. Arthrosc Tech 1:e95–e99PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Taketomi S, Nakagawa T, Takeda H, Nakajima K, Nakayama S, Fukai A, Hirota J, Kachi Y, Kawano H, Miura T, Fukui N, Nakamura K (2011) Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first? Knee Surg Sports Traumatol Arthrosc 19:424–431PubMedCrossRefGoogle Scholar
  35. 35.
    Tashiro Y, Okazaki K, Miura H, Matsuda S, Yasunaga T, Hashizume M, Nakanishi Y, Iwamoto Y (2009) Quantitative assessment of rotatory instability after anterior cruciate ligament reconstruction. Am J Sports Med 37:909–916PubMedCrossRefGoogle Scholar
  36. 36.
    Tensho K, Kodaira H, Yasuda G, Yoshimura Y, Narita N, Morioka S, Kato H, Saito N (2011) Anatomic double-bundle anterior cruciate ligament reconstruction, using CT-based navigation and fiducial markers. Knee Surg Sports Traumatol Arthrosc 19:378–383PubMedCrossRefGoogle Scholar
  37. 37.
    Toritsuka Y, Amano H, Kuwano M, Iwai T, Mae T, Ohzono K, Shino K (2009) Outcome of double-bundle ACL reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 17:456–463PubMedCrossRefGoogle Scholar
  38. 38.
    Tsuda E, Ishibashi Y, Fukuda A, Yamamoto Y, Tsukada H, Ono S (2010) Tunnel position and relationship to postoperative knee laxity after double-bundle anterior cruciate ligament reconstruction with a transtibial technique. Am J Sports Med 38:698–706PubMedCrossRefGoogle Scholar
  39. 39.
    van Eck CF, Morse KR, Lesniak BP, Kropf EJ, Tranovich MJ, van Dijk CN, Fu FH (2010) Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc 18:1184–1188PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–12PubMedCrossRefGoogle Scholar
  41. 41.
    Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107PubMedCrossRefGoogle Scholar
  42. 42.
    Zantop T, Diermann N, Schumacher T, Schanz S, Fu F, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMedCrossRefGoogle Scholar
  43. 43.
    Zantop T, Wellmann M, Fu F, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRefGoogle Scholar
  44. 44.
    Zhao J, Peng X, He Y, Wang J (2006) Two-bundle anterior cruciate ligament reconstruction with eight-stranded hamstring tendons: four-tunnel technique. Knee 13:36–41PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Shuji Taketomi
    • 1
    Email author
  • Hiroshi Inui
    • 1
  • Kensuke Nakamura
    • 1
  • Jinso Hirota
    • 1
  • Takaki Sanada
    • 1
  • Hironari Masuda
    • 2
  • Hideki Takeda
    • 1
  • Sakae Tanaka
    • 1
  • Takumi Nakagawa
    • 2
  1. 1.Department of Orthopaedic Surgery, Faculty of MedicineUniversity of TokyoBunkyo-kuJapan
  2. 2.Department of Orthopaedic SurgeryTeikyo University School of MedicineTokyoJapan

Personalised recommendations