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The posterior horn of the lateral meniscus is a reliable novel landmark for femoral tunnel placement in ACL reconstruction

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

Abstract

Purpose

Femoral tunnel placement is essential for good outcome in anterior cruciate ligament (ACL) reconstruction. In the past, several attempts have been made to optimize femoral tunnel placement. It was observed that the posterior horn of the lateral meniscus was always located directly below to the desired femoral ACL tunnel position, when the knee was brought to deep flexion (> 120°). The goal of the present study was to verify the hypothesis that the posterior horn of the lateral meniscus can be used as a landmark for femoral tunnel placement.

Methods

Out of a consecutive series of ACL reconstructions done by a single surgeon, 55 lateral radiographs were evaluated according to the quadrant method by Bernard and Hertel. Additionally, on anterior-posterior radiographs the femoral tunnel angle was determined.

Results

In the present case series the posterior horn of the lateral meniscus could be identified and used as a landmark for femoral tunnel placement in all cases. The mean tunnel depth was 24 ± 5.1% and the mean tunnel height was 31.3 ± 5.7%. The mean femoral tunnel angle was 41 ± 4.9° using the anatomical axis as a reference. Compared to previous cadaver studies the data of the present study were within their anatomical range of the native ACL insertion site.

Conclusion

The suggested technique using the posterior horn of the lateral meniscus as a landmark for femoral tunnel placement showed reproducible results and matches the native ACL insertion site compared to previous cadaveric studies. In particular, non-experienced ACL surgeons will benefit from this apparent landmark and the corresponding easy-to-use ACL reconstruction method.

Level of evidence

IV.

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Authors and Affiliations

  1. Sporthopaedicum Berlin, Berlin, Germany

    Andreas Weiler, Michael Wagner & Christoph Kittl

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany

    Christoph Kittl

  3. Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK

    Christoph Kittl

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  1. Andreas Weiler
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  2. Michael Wagner
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Correspondence to Christoph Kittl.

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The authors declare that they have no conflict of interest.

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Andreas Weiler receives royalties from Store.

Ethical approval

This study was approved by the ethical committee of the Berlin medical association (Ärztekammer 10969 Berlin, Germany).

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Weiler, A., Wagner, M. & Kittl, C. The posterior horn of the lateral meniscus is a reliable novel landmark for femoral tunnel placement in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 1384–1391 (2018). https://doi.org/10.1007/s00167-017-4759-4

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  • DOI: https://doi.org/10.1007/s00167-017-4759-4

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