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Simulated anterior cruciate ligament reconstruction using preoperative three-dimensional computed tomography

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

Abstract

Purpose

The aim of this study was to ascertain the ideal far anteromedial portal location to avoid damaging the medial femoral condyle in anterior cruciate ligament (ACL) reconstruction.

Methods

Forty patients received preoperative computed tomography (CT) scans at 120° of knee flexion. Three-dimensional CT (3D CT) reconstruction of the knee was performed using volume rendering. The insertion of anteromedial (AM) and posterolateral bundle of ACL of the femur was marked on the 3D CT. A line (Line A) was drawn 8-mm proximal and parallel to the anterior ridge of the medial tibial plateau. A tangential line to the medial femoral condyle was drawn from the AM position that was already marked to Line A. The length from the intersection of the lines to the medial edge of the patellar tendon was measured.

Results

In all 40 patients, the mean length between the medial edge of the patellar tendon and the far anteromedial portal was 27.5 ± 0.7 mm (range 19.8–34.5). In men 29.5 ± 0.7 mm (range 25–34.5); 28.7 ± 0.8 mm in the shorter group (height ≤ 170 cm) and 30.1 ± 1.2 mm in the taller group (height ≥ 170 cm). In women 25.5 ± 1.0 mm (range 19.8–30.5); 22.9 ± 1.0 mm in the shorter group (height ≤ 158 cm) and 29.6 ± 0.5 mm in the taller group (height ≥ 158 cm).

Conclusions

An optimum far anteromedial portal position was proposed. Knowing the optimum location of the far anteromedial portal position before surgery allows the surgeons to perform more safety ACL reconstruction.

Level of evidence

IV.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Programs for Applied Biomedicine, Division of Clinical Medical Science, Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Makoto Nishimori, Nobuo Adachi, Atsuo Nakamae & Mitsuo Ochi

  2. Department of Physiological Therapy and Occupational Therapy, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan

    Masataka Deie

  3. Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan

    Minoru Ishifuro

Authors
  1. Makoto Nishimori
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  2. Masataka Deie
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  3. Nobuo Adachi
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  4. Atsuo Nakamae
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  5. Minoru Ishifuro
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  6. Mitsuo Ochi
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Correspondence to Makoto Nishimori.

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Nishimori, M., Deie, M., Adachi, N. et al. Simulated anterior cruciate ligament reconstruction using preoperative three-dimensional computed tomography. Knee Surg Sports Traumatol Arthrosc 22, 1175–1181 (2014). https://doi.org/10.1007/s00167-013-2584-y

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  • DOI: https://doi.org/10.1007/s00167-013-2584-y

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