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Shallow knee flexion angle during femoral tunnel creation using modified transtibial technique can reduce femoral graft bending angle in ACL reconstruction

  • Tomohiro Tomihara
  • Yusuke Hashimoto
  • Masatoshi Taniuchi
  • Junsei Takigami
  • Shinji Takahashi
  • Yohei Nishida
  • Nagakazu Shimada
KNEE
  • 40 Downloads

Abstract

Purpose

The purpose of this study was to compare femoral graft bending angle between patients with femoral tunnel reamed at less than 80° of knee flexion and those with 80° and above in anatomical anterior cruciate ligament (ACL) reconstruction using modified transtibial technique.

Methods

Forty-eight patients who underwent ACL reconstruction using bone–patellar-tendon–bone autograft in modified transtibial technique and CT scan at 1 week postoperatively were included in this study. A femoral guidewire insertion into aimed femoral position at the medial wall of the femoral lateral condyle was started at about 75° of knee flexion. When the tip of the guidewire was blown out into femoral posterior wall, the guidewire was inserted again after increasing knee flexion angle. Distance from femoral tunnel exit on the femoral lateral cortex–femoral posterior cortex (Distance-E) was measured on postoperative lateral radiograph. Femoral and tibial tunnel position was measured on 3-D CT images. In addition, femoral graft bending angle was measured on reconstructed 2-D CT images. Patients were divided into two groups depending on whether femoral tunnel was created at less than 80° of knee flexion (group A) or 80° or more (group B).

Results

There were 32 patients in group A and 16 patients in group B, respectively. Average knee flexion angle was 77.2° [standard deviation (SD) 1.6] in group A and 83.6° (SD 2.4) in group B, respectively (p < 0.05). Average Distance-E was 5.1 mm (SD 2.6) in group A and 6.6 mm (SD 3.8) in group B, respectively. There was no significant difference in the femoral and tibial tunnel position between group A and B. Femoral graft bending angle was significantly smaller in group A [average angle: 50.9° (SD 6.6)] than in group B [average angle: 55.0° (SD 6.6)] (p < 0.05).

Conclusions

Anatomical femoral tunnel was able to be created at less than 80° of knee flexion in two-thirds of patients. Shallower flexion angle (less than 80°) provided gentler femoral graft bending angle compared to 80° or more of knee flexion. Therefore, femoral tunnel creation in modified transtibial technique should be started at between 75° and 80° of knee flexion to reduce femoral graft bending angle. Shallow knee flexion angle during femoral tunnel creation using modified transtibial technique can reduce femoral graft bending angle and may lead to better clinical outcomes in ACL reconstruction.

Levels of evidence

Retrospective comparative study, Level III.

Keywords

Anterior cruciate ligament Graft bending angle Transtibial Bone–patellar tendon–bone autograft 

Notes

Acknowledgements

We appreciate the guidance of Dr. Shigeo Fukuoka, Nishigima Hospital, Japan. Modified transtibial technique in this study was performed based on the technique designed by Dr. Fukuoka.

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest associated with this manuscript.

Ethical approval

This study was approved by the Shimada Hospital Institutional Review Board (ID number of approval: 2017-002).

Informed consent

Informed consent was obtained from all subjects.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Tomohiro Tomihara
    • 1
  • Yusuke Hashimoto
    • 2
  • Masatoshi Taniuchi
    • 1
  • Junsei Takigami
    • 1
  • Shinji Takahashi
    • 2
  • Yohei Nishida
    • 2
  • Nagakazu Shimada
    • 1
  1. 1.Department of Orthopaedic SurgeryShimada HospitalHabikinoJapan
  2. 2.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

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