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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 8, pp 2680–2690 | Cite as

Anatomical rectangular tunnels identified with the arthroscopic landmarks result in excellent outcomes in ACL reconstruction with a BTB graft

  • Yuta TachibanaEmail author
  • Konsei Shino
  • Tatsuo Mae
  • Ryo Iuchi
  • Yasuhiro Take
  • Shigeto Nakagawa
KNEE

Abstract

Purpose

To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone–patellar tendon–bone (BTB) graft.

Methods

Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively.

Results

Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as ‘normal’ or ‘nearly normal’. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT- 1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from − 1 to + 2 mm.

Conclusion

By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients.

Level of evidence

Case series, Level IV.

Keywords

Anatomic rectangular tunnel Anterior cruciate ligament reconstruction Bone-patellar tendon-bone graft Tunnel location 3-Dimensional computed tomography Clinical outcomes Bony landmark Remnant Proportion of tunnel aperture 

Abbreviations

ART

Anatomic rectangular tunnel

ACLR

Anterior cruciate ligament reconstruction

BTB

Bone-patellar tendon-bone

3-D

Three-dimensional

CT

Computed tomography

IKDC

International Knee Documentation Committee

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest associated with the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the present study.

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Copyright information

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

Authors and Affiliations

  1. 1.Sports Orthopaedic CenterYukioka HospitalOsakaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka University Graduate School of MedicineSuitaJapan

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