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Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT

Knee Surgery, Sports Traumatology, Arthroscopy volume 19, pages 674–679 (2011)Cite this article

Abstract

Purpose

To reveal the relationship between anatomically placed anterior cruciate ligament (ACL) graft and the intercondylar roof using three-dimensional computed tomography (3D-CT).

Methods

Twenty-four patients undergoing anatomical double-bundle ACL reconstruction were included in this study. Anatomical double-bundle ACL reconstruction was performed with two femoral tunnels (antero-medial; AM and postero-lateral; PL) and two tibial tunnels. Hamstring autograft was used in all cases. Six to eight weeks after operation and when the subjects had obtained full extension of the knee, 3D-CT was performed with full knee extension. In the 3D-CT, the ACL graft was also reconstructed and visualized three dimensionally. Tunnel placement was evaluated with 3D-CT and intra-operative radiographs. The extension angle of the knee was also evaluated with 3D-CT.

Results

No intercondylar roof impingement was observed. In 12 subjects, the ACL graft touched the roof (Touch group) but no graft deformation was observed. In 12 subjects, no roof-graft contact was observed (Non-touch group). No significant difference in femoral and tibial tunnel placement was observed between the Touch and Non-touch groups. All subjects attained full knee extension.

Conclusion

We believe that 3D-CT is an effective means of evaluating impingement after ACL reconstruction. For the clinical relevance, when the grafts are positioned in an anatomical fashion, there is no risk of impingement, and surgeons can perform anatomical double-bundle ACL as an impingement-free reconstruction. Level of evidence: III (Case control study).

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References

  1. Bernard M, Hertel P, Hornung H, Cierpinski TH (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–22

    PubMed  CAS  Google Scholar 

  2. Brophy RH, Selby RM, Altchek DW (2006) Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft. Arthroscopy 22(683):e1–e5

    PubMed  Google Scholar 

  3. Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006

    PubMed  Article  Google Scholar 

  4. Colvin AC, Shen W, Musahl V, Fu FH (2009) Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 17:956–963

    PubMed  Article  Google Scholar 

  5. Cuomo P, Edwards A, Giron F, Bull AMJ, Amis AA, Aglietti P (2006) Validation of the 65° howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75

    PubMed  Article  Google Scholar 

  6. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225

    PubMed  Article  Google Scholar 

  7. Fung DT, Zhang LQ (2003) Modeling of ACL impingement against the intercondylar notch. Clin Biomech 18:933–941

    Article  Google Scholar 

  8. Goss BC, Howell SM, Hull ML (1998) Quadriceps load aggravates and roofplasty mitigates active impingement of anterior cruciate ligament grafts against the intercondylar roof. J Orthopaed Res 16:611–617

    Article  CAS  Google Scholar 

  9. Goss BC, Hull ML, Howell SM (1997) Contact pressure and tension in anterior cruciate ligament grafts subjected to roof impingement during passive extension. J Orthopaed Res 15:263–268

    Article  CAS  Google Scholar 

  10. Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries. J Am Acad Orthop Surg 8:141–150

    PubMed  CAS  Google Scholar 

  11. Harner CD, Vogrin TM (2002) What’s new in sports medicine? J Bone Joint Surg Am 84:1095–1099

    PubMed  Google Scholar 

  12. Hame SL, Markolf KL, Hunter DM, Oakes DA, Zoric B (2003) Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Arthroscopy 19:340–345

    PubMed  Article  Google Scholar 

  13. Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6:S49–S55

    PubMed  Article  Google Scholar 

  14. Inoue M, Tokuyasu S, Kuwahara S et al (2010) Tunnel location in transparent 3-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial technique. Knee Surg Sports Traumatol Arthrosc 18:1176–1183

    PubMed  Article  Google Scholar 

  15. Iriuchishima T, Tajima G, Ingham SJ et al (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594

    PubMed  Article  Google Scholar 

  16. Iriuchishima T, Ingham SJ, Tajima G et al (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231

    PubMed  Article  Google Scholar 

  17. Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617

    PubMed  Article  Google Scholar 

  18. Iwahashi T, Shino K, Nakata K, Otsubo H, Suzuki T, Amano H, Nakamura N (2010) Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy 26:S13–S20

    PubMed  Article  Google Scholar 

  19. Jagodzinski M, Leis A, Iselborn KW, Mall G, Nerlich M, Bosch U (2003) Impingement pressure and tension forces of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 11:85–90

    PubMed  CAS  Google Scholar 

  20. Jagodzinski M, Richter GM, Passler HH (2000) Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:11–19

    PubMed  Article  CAS  Google Scholar 

  21. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304

    PubMed  Article  Google Scholar 

  22. Mae T, Shino K, Miyama T et al (2001) Single versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716

    PubMed  Article  CAS  Google Scholar 

  23. Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628

    PubMed  Article  Google Scholar 

  24. Muneta T, Yamamoto H, Ishibashi T, Asahina S, Murakami S, Furuya K (1995) The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees. Arthroscopy 11:57–62

    PubMed  Article  CAS  Google Scholar 

  25. Sahasrabudhe A, Christel P, Anne F, Appleby D, Basdekis G (2010) Postoperative evaluation of tibial footprint and tunnels characteristics after anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers. Knee Surg Sports Traumatol Arthrosc 18:1599–1606

    PubMed  Article  Google Scholar 

  26. Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position, anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146

    PubMed  Article  CAS  Google Scholar 

  27. Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189

    PubMed  Article  Google Scholar 

  28. Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement. Arthroscopy 17:408–411

    PubMed  Article  CAS  Google Scholar 

  29. Tajima G, Iriuchishima T, Ingham SJ et al (2010) Anatomic double-bundle anterior cruciate ligament reconstruction restores patellofemoral contact areas and pressures more closely than nonanatomic single-bundle reconstruction. Arthroscopy 26:1302–1310

    PubMed  Article  Google Scholar 

  30. Van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163

    PubMed  Article  Google Scholar 

  31. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  32. Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251

    PubMed  Article  Google Scholar 

  33. Zantop T, Peterson W (2008) Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique. Arch Orthop Trauma Surg 128:1287–1294

    PubMed  Article  Google Scholar 

  34. Zantop T, Wellmann M, Fu FH, Peterson W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Orthopaedic Surgery, Surugadai Nihon University Hospital, Chiyodaku Kanda Surugadai 1-8-13, Tokyo, Japan

    Takanori Iriuchishima, Takashi Horaguchi, Tatsuya Kubomura & Yusuke Morimoto

  2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Freddie H. Fu

Authors
  1. Takanori Iriuchishima
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  2. Takashi Horaguchi
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  3. Tatsuya Kubomura
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  4. Yusuke Morimoto
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  5. Freddie H. Fu
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Correspondence to Takanori Iriuchishima.

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Iriuchishima, T., Horaguchi, T., Kubomura, T. et al. Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc 19, 674–679 (2011). https://doi.org/10.1007/s00167-010-1331-x

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  • DOI: https://doi.org/10.1007/s00167-010-1331-x

Keywords

  • Anterior Cruciate Ligament
  • Reconstruction
  • Anatomical
  • Double bundle
  • Impingement
  • 3D-CT