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Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

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Clinical Orthopaedics and Related Research

Abstract

Grafts placed too anteriorly on the femur are reportedly a common cause of failure in anterior cruciate ligament reconstruction. Some studies suggest more anatomic femoral tunnel placement improves kinematics. The ability of the transtibial technique and a tibial tunnel-independent technique (placed transfemorally outside-in) to place the guide pin near the center of the femoral attachment of the anterior cruciate ligament was compared in 12 cadavers. After arthroscopic placement of the guide pins, the femur was dissected and the three-dimensional geometry of the femur, anterior cruciate ligament footprint, and positions of each guide pin were measured. The transtibial guide-pin placement was 7.9 ± 2.2 mm from the center of the footprint (near its anterior border), whereas the independent technique positioned the guide pin 1.9 ± 1.0 mm from the center. The center of the footprint was within 2 mm of an anteroposterior line through the most posterior border of the femoral cartilage in the notch and a proximodistal line through the proximal margin of the cartilage at the capsular reflection. More accurate placement of the femoral tunnel might reduce the incidence of graft failure and might reduce long-term degeneration observed after reconstruction although both would require clinical confirmation.

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Acknowledgments

We gratefully acknowledge the advice of Dean C. Taylor, MD throughout this project. We thank Richard R. Glisson and Clinton A. Leiweke for technical assistance. Arthrex kindly provided the cadavers and surgical equipment used in this study. The financial support of the Division of Orthopaedics and the Sports Medicine Center is also gratefully acknowledged.

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Authors and Affiliations

  1. Division of Orthopaedics, Sports Medicine Center, Duke University Medical Center, Durham, NC, USA

    Maria K. Kaseta MD, Louis E. DeFrate ScD, Brian L. Charnock AB, Robert T. Sullivan MD & William E. Garrett Jr MD, PhD

  2. Orthopaedic Bioengineering Laboratory, Duke University Medical Center, 3093, Durham, NC, 27710, USA

    Louis E. DeFrate ScD

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  1. Maria K. Kaseta MD
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  2. Louis E. DeFrate ScD
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  3. Brian L. Charnock AB
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  5. William E. Garrett Jr MD, PhD
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Correspondence to Louis E. DeFrate ScD.

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The institution of the authors has received funding from Arthrex.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Kaseta, M.K., DeFrate, L.E., Charnock, B.L. et al. Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction. Clin Orthop Relat Res 466, 1467–1474 (2008). https://doi.org/10.1007/s11999-008-0238-z

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