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Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage

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

Abstract

Purpose

To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint.

Methods

Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel.

Results

A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45 % of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang.

Conclusion

A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics committee approval

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Departments of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium

    P. Verdonk

  2. University Hospitals Leuven, Leuven, Belgium

    J. Bellemans

  3. Department of Orthopedic Surgery and Traumatology, GZA Sint-Augustinus, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium

    H. Van der Bracht & B. Stuyts

  4. AZ Groeninge, Kortrijk, Belgium

    L. Verhelst

  5. Department of Anatomy, University of Stellenbosch, Stellenbosch, South Africa

    B. Page

Authors
  1. H. Van der Bracht
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  2. L. Verhelst
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  3. B. Stuyts
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  4. B. Page
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  5. J. Bellemans
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  6. P. Verdonk
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Corresponding author

Correspondence to H. Van der Bracht.

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Van der Bracht, H., Verhelst, L., Stuyts, B. et al. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage. Knee Surg Sports Traumatol Arthrosc 22, 1030–1039 (2014). https://doi.org/10.1007/s00167-013-2416-0

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  • DOI: https://doi.org/10.1007/s00167-013-2416-0

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