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The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant-preserving anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

The aim of this retrospective cohort study was to investigate whether the apex of the deep cartilage (ADC) could help surgeons position the femoral tunnel accurately in remnant-preserving anterior cruciate ligament (ACL) reconstruction (ACLR).

Methods

In the current retrospective cohort study, a total of 134 patients who underwent ACLR between 2016 and 2020 were included. The femoral tunnel position was located using ADC as the landmark. The patients were divided into two groups: the remnant-preserving group (RP group, n = 68) underwent remnant-preserving ACLR, and the nonremnant group (NRP group, n = 66) underwent traditional ACLR with remnant removal. Postoperatively, the femoral tunnel position was evaluated on 3D-CT. The length from the ADC to the shallow cartilage margin (L) and to the centre of the femoral tunnel (l) and the length from the centre of the femoral tunnel to a low cartilage ratio in the direction from high to low (H) were measured.

Results

The l/L values of the RP and NRP groups were both 0.4 ± 0.1 after rounding (n.s.), and the H values were 9.3 ± 1.6 mm and 9.3 ± 1.7 mm, respectively (n.s.). There was no significant difference in l/L or H between the two groups. The estimation plot also showed high consistency of H and l/L of the two groups. The inter- and intraobserver reliability of I, L, l/L, and H were almost perfect.

Conclusions

The apex of the deep cartilage is a good landmark for positioning the femoral tunnel in remnant-preserving ACL reconstruction.

Level of evidence

Level III.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

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Funding

This work was supported by grants from Beijing Nova Program (No. Z201100006820011), Beijing Nova Program Cross Cooperation Project (No. Z211100002121015).

Author information

Author notes

  1. Zhang Keying and Meng Qingyang contributed equally to this work.

Authors and Affiliations

  1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China

    Keying Zhang, Qingyang Meng, Jingwei Zhang, Yitian Gao, Yuping Yang, Ping Liu, Cheng Wang, Yong Ma & Weili Shi

  2. Beijing Key Laboratory of Sports Injuries, Beijing, China

    Keying Zhang, Qingyang Meng, Jingwei Zhang, Yitian Gao, Yuping Yang, Ping Liu, Cheng Wang, Yong Ma & Weili Shi

  3. Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China

    Keying Zhang, Qingyang Meng, Jingwei Zhang, Yitian Gao, Yuping Yang, Ping Liu, Cheng Wang, Yong Ma & Weili Shi

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  1. Keying Zhang
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Contributions

Conceptualization and surgical data provision: SW, MY; data collection: ZK, GY, MQ; Statistical analysis: ZK, MQ; Original draft preparation: ZK, ZJ; supervision and draft revision: YY, LP, WC, MY, SW.

Corresponding authors

Correspondence to Yong Ma or Weili Shi.

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Zhang, K., Meng, Q., Zhang, J. et al. The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant-preserving anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07656-w

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