Sagittal femoral condyle morphology correlates with femoral tunnel length in anatomical single bundle ACL reconstruction
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The purpose of this study was to reveal the correlation between femoral tunnel length and the morphology of the femoral intercondylar notch in anatomical single bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT).
Thirty subjects undergoing anatomical single bundle ACL reconstruction were included in this study (23 female, 7 male: average age 45.5 ± 16.7). In the anatomical single bundle ACL reconstruction, the femoral and tibial tunnels were created close to the antero-medial bundle insertion site with trans-portal technique. Using post-operative three-dimensional computed tomography (3D-CT), accurate axial and lateral views of the femoral condyle were evaluated. The correlation of femoral tunnel length, which was measured intra-operatively, with the transepicondylar length (TEL), notch width index, notch outlet length, the notch area (axial), length of Blumensaat’s line, and the height and area of the lateral wall of the femoral intercondylar notch was statistically analyzed. Tunnel placement was also evaluated using a Quadrant method.
The average femoral tunnel length was 35.4 ± 4.4 mm. The average TEL, NWI, notch outlet length, and the axial notch area, were 76.9 ± 5.1 mm, 29.1 ± 3.8%, 19.5 ± 3.9 mm, and 257.4 ± 77.4 mm2, respectively. The length of Blumensaat’s line and the height and area of the lateral wall of the femoral intercondylar notch were 33.8 ± 3.2 mm, 22.8 ± 2.3 mm, and 738.7 ± 129 mm2, respectively. The length of Blumensaat’s line, the height, and the area of the lateral wall of the femoral intercondylar notch were significantly correlated with femoral tunnel length. Femoral tunnel placement was 23.4 ± 4.5% in a shallow-deep direction and 35.4 ± 8.8% in a high-low direction.
The length of Blumensaat’s line, height, and area of the lateral wall of the femoral intercondylar notch are correlated with femoral tunnel length in anatomical single bundle ACL reconstruction. For clinical relevance, these parameters are useful in predicting the length of the femoral tunnel in anatomical single bundle ACL reconstruction for the prevention of extremely short femoral tunnel creation.
Level of evidence
Case controlled study, Level III.
KeywordsAnterior cruciate ligament Anatomy Tunnel length Femoral condyle 3D-CT
Anterior cruciate ligament
Compliance with ethical standards
Conflict of interest
Takanori Iriuchishima, Fu FH, Keinosuke Ryu, Makoto Suruga, Yoshiyuki Yahagi, and Sin Aizawa declare that they have no conflict of interest.
This study was performed in accordance with the ethics principles of the Declaration of Helsinki and was conducted with the approval of the institutional review boards of the Kamimoku Hot springs Hospital.
- 1.Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH (2013) Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg 5(1):26–35CrossRefPubMedCentralPubMedGoogle Scholar
- 21.Luites JW, Wymenga AB, Blankevoort L et al (2007) Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 15(12):1422–1431CrossRefPubMedCentralPubMedGoogle Scholar
- 26.Robin BN, Jani SS, Marvil SC, Reid JB, Schillhammer CK, Lubowitz JH (2015) Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 31(7):1412–1417CrossRefPubMedGoogle Scholar
- 28.Siebold R, Ellert T, Metz S et al (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement-a cadaver study. Arthroscopy 24(5):585–592CrossRefPubMedGoogle Scholar
- 31.Tashiro Y, Okazaki K, Uemura M, Toyoda K, Osaki K, Matsubara H, Hashizume M, Iwamoto Y (2014) Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models. Open Access J Sports Med 5:65–72CrossRefPubMedCentralPubMedGoogle Scholar