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Anatomic femoral tunnel placement is difficult by the transtibial technique: comparison of three different femoral tunnel drilling techniques in double-bundle anterior cruciate ligament reconstructions

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 584–593 (2020)Cite this article

Abstract

Purpose

To compare the position and direction of femoral and tibial tunnels for both the anteromedial bundle (AMB) and posterolateral bundle (PLB) among three different femoral tunnel drilling techniques, transtibial (TT), transportal (TP), and outside-in (OI) techniques, in anatomic double-bundle ACL reconstruction to clarify advantages and disadvantages of each technique.

Methods

One-hundred and thirty-nine patients underwent primary ACL reconstruction with an autologous semitendinosus tendon in our institution between 2014 and 2016. Thirteen patients were excluded according to the exclusion criteria. Of the 126 patients, 98 patients agreed to be included in this study. Patients were then randomized into three groups according to the femoral tunnel drilling technique; the TT, TP, and OI groups. Femoral and tibial tunnel angles and positions were measured using three-dimensional computed tomography.

Results

Of patients who agreed to be included in this study, eight patients (seven in TT and one in OI) were excluded since the femoral tunnel could not be created at the intended position. Eighty-six patients (29 in TT, 29 in TP, and 28 in OI) were included for the analyses. Tunnel angles, as well as tunnel lengths, had significant differences among different techniques depending on each technique’s characteristics. In terms of tunnel position, femoral tunnel positions of both the AMB and PLB in the TT group were significantly higher than those in the TP group (AMB: p = 0.003, PLB: p = 0.001), and the PLB tunnel position in the TP group had significantly smaller vaciance than that in the TT group (p = 0.004) and OI group (0.002).

Conclusions

The femoral tunnel positions created by the TT technique were significantly higher, with larger variance, than the TP technique in double-bundle ACL reconstruction, although the positions seemed to be within anatomical footprint. In addition, there were several cases in which femoral tunnels could not be created at the intended position by the TT technique.

Level of evidence

I

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Acknowledgments

We thank Atsushi Okawa, MD, PhD for continuous support, Miyoko Ojima for management of our department and Ronald G. Berisle for English correction.

Funding

No external source of funding was used.

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Affiliations

  1. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kaori Nakamura, Tomomasa Nakamura, Masafumi Horie, Hiroki Katagiri, Yusuke Nakagawa, Masaki Amemiya, Takeshi Muneta & Hideyuki Koga

  2. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hiroki Katagiri, Koji Otabe, Yusuke Nakagawa, Ichiro Sekiya & Hideyuki Koga

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  1. Kaori Nakamura
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  2. Tomomasa Nakamura
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  3. Masafumi Horie
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Correspondence to Hideyuki Koga.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of Tokyo Medical and Dental University institutional review board (Research protocol identification number: 1842) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Nakamura, K., Nakamura, T., Horie, M. et al. Anatomic femoral tunnel placement is difficult by the transtibial technique: comparison of three different femoral tunnel drilling techniques in double-bundle anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 28, 584–593 (2020). https://doi.org/10.1007/s00167-019-05740-8

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  • DOI: https://doi.org/10.1007/s00167-019-05740-8

Keywords

  • Anterior cruciate ligament
  • Tunnel position
  • Transtibial technique
  • Transportal technique
  • Outside-in technique
  • Randomized controlled trial