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ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

To evaluate the influence of tibial and femoral tunnel position in ACL reconstruction on knee kinematics, we compared ACL reconstruction with a tibial and femoral tunnel in anteromedial (AM-AM reconstruction) and in posterolateral footprint (PL-PL reconstruction) with a reconstruction technique with tibial posterolateral and femoral anteromedial tunnel placement (PL-AM reconstruction). In 9 fresh-frozen human cadaveric knees, the knee kinematics under simulated Lachman (134 N anterior tibial load) and a simulated pivot shift test (10 N/m valgus and 4 N/m internal tibial torque) were determined at 0°, 30°, 60°, and 90° of flexion. Kinematics were recorded for intact, ACL-deficient, and single-bundle ACL reconstructed knees using three different reconstruction strategies in randomized order: (1) PL-AM, (2) AM-AM and (3) PL-PL reconstructions. Under simulated Lachman test, single-bundle PL-AM reconstruction and PL-PL reconstructions both showed significantly increased anterior tibial translation (ATT) at 60° and 90° when compared to the intact knee. At all flexion angles, AM-AM reconstruction did not show any statistical significant differences in ATT compared to the intact knee. Under simulated pivot shift, PL-AM reconstruction resulted in significantly higher ATT at 0°, 30°, and 60° knee flexion and AM-AM reconstructions showed significantly higher ATT at 30° compared to the intact knee. PL-PL reconstructions did not show any significant differences to the intact knee. AM-AM reconstructions restore the intact knee kinematics more closely when compared to a PL-AM technique resembling a transtibial approach. PL-PL reconstructions showed increased ATT at higher flexion angles, however, secured the rotational stability at all flexion angles. Due to the independent tibial and femoral tunnel location, a medial portal technique may be superior to a transtibial approach.

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Acknowledgments

Supported by outside funding or grant from the German Speaking Arthroscopy Association (AGA).

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Weatfaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany

    Mirco Herbort, Simon Lenschow & Thore Zantop

  2. Department of Orthopedic Surgery, Center of Sports Medicine, University of Pittsburgh Medical Center, Kaufmann Building, Suite 1011, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA

    Freddie H. Fu

  3. Department of Traumatology, Martin Luther Hospital, Caspar-Theyss-Str.27-31, 14193, Berlin-Grunewald, Germany

    Wolf Petersen

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  1. Mirco Herbort
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  2. Simon Lenschow
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  5. Thore Zantop
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Correspondence to Mirco Herbort.

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Herbort, M., Lenschow, S., Fu, F.H. et al. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18, 1551–1558 (2010). https://doi.org/10.1007/s00167-010-1163-8

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