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Tibial Bone Tunnel Placement (Arthroscopically and with Fluoroscopy)

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Anterior Cruciate Ligament Reconstruction

Abstract

The choice of the tibial tunnel position has a significant effect on the outcome of ACL reconstruction. This issue is really relevant, and the most common surgical error is thought to be poor tunnel position, which leads to poor rotational stability or increased graft stress and early failure with nonanatomic reconstruction [1]. Graft placement in single-bundle ACL reconstruction is essential for knee mechanic and transplant survival, but to know if the tibial bone tunnel is in an optimal position, it is primordial to define what is an “ideal tibial tunnel.” Karlson defines four major principles to perform anatomic reconstruction: restore the native insertion site anatomy, restore the two functional bundles and they may be restored as one single graft “anatomic single-bundle reconstruction,” address the tension behavior of the native ACL, and, at least, individualize the surgical procedure for each patient.

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References

  1. Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011) Anatomic single-and double-bundle anterior cruciate ligament reconstruction. Part 1: Basic science. Am J Sports Med 39:1789–1799

    Article  PubMed  Google Scholar 

  2. Kato Y, Maeyama A, Lertwanich P, Wang JH, Ingham SJ, Kramer S, Martins CQ, Smolinski P, Fu FH (2013) Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:816–823

    Article  PubMed Central  PubMed  Google Scholar 

  3. Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction. Part 2: Clinical application of surgical technique. Am J Sports Med 39:2016–2026

    Article  PubMed  Google Scholar 

  4. Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36:2083–2090

    Article  PubMed  Google Scholar 

  5. Berg EE (1993) Parsons’ knob (tuberculum intercondylare tertium). A guide to tibial anterior cruciate ligament insertion. Clin Orthop Relat Res 292:229–231

    PubMed  Google Scholar 

  6. Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH (2009) A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17:213–219

    Article  PubMed  Google Scholar 

  7. Hulet C, Lebel B, Colombet P, Pineau V, Locker B (2011) Traitement chirurgical des lésions du ligament Croisé antérieur. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales- Orthopedie traumatologie, pp 44–780

    Google Scholar 

  8. Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH (2012) Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Knee Surg Sports Traumatol Arthrosc 20:62–68

    Article  PubMed  Google Scholar 

  9. Siebold SR, Ellert T, Metz S, Metz J (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161

    Article  PubMed  Google Scholar 

  10. Hwang MD, Piefer JW, Lubowitz JH (2012) Anterior cruciate ligament tibial footprint anatomy: systematic review of the 21st century literature. Arthroscopy 28:728–734

    Article  PubMed  Google Scholar 

  11. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992

    Article  PubMed  Google Scholar 

  12. Katsen P, Szczodry M, Irrgang J, Kropf E, Costello J, Fu FH (2010) What is the role of intra operative fluoroscopic measurements to determine tibial tunnel, placement in anatomical anterior cruciate ligament reconstruction? Knee Surg Sports Traumatol Arthrosc 18:1169–1175

    Article  Google Scholar 

  13. Zantop T, Wellmann M, Fu FH, Peterson W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72

    Article  PubMed  Google Scholar 

  14. Iriuchishima T, Ingham SJ, Tajima G et al (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231

    Article  PubMed  Google Scholar 

  15. Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27:391–398

    Article  PubMed  Google Scholar 

  16. 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 5:26–35

    Article  PubMed Central  PubMed  Google Scholar 

  17. Forsythe B, Kopf S, Wong AK, Martins CAQ, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426

    Article  PubMed  Google Scholar 

  18. Pietrini SD, Ziegler CG, Anderson CJ, Wijdicks CA, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF (2011) Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 19:792–800

    Article  PubMed  Google Scholar 

  19. Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288

    Article  CAS  PubMed  Google Scholar 

  20. Hutchinson MR, Bae TS (2001) Reproducibility of anatomic tibial landmarks for anterior cruciate ligament reconstructions. Am J Sports Med 29:777–780

    CAS  PubMed  Google Scholar 

  21. Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S, Engebretsen L, LaPrade RF (2011) Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39:743–752

    Article  PubMed  Google Scholar 

  22. Sonnery-Cottet B, Archbold P, Zayni R, Thaunat M, Bortolletto J, Fayard JM, Chambat P (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthop Traumatol Surg Res 97:870–873

    Article  CAS  PubMed  Google Scholar 

  23. Borbon CA, Mouzopoulos G, Siebold R (2012) Why perform an ACL augmentation? Knee Surg Sports Traumatol Arthrosc 20:245–251

    Article  PubMed  Google Scholar 

  24. Stäubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Knee Surg Sports Traumatol Arthrosc 2:138–146

    Article  PubMed  Google Scholar 

  25. Jackson DW, Gasser SI (1994) Tibial tunnel placement in ACL reconstruction. Arthroscopy 10:124–131

    Article  CAS  PubMed  Google Scholar 

  26. Kongcharoensombat W, Ochi M, Abouheif M, Adachi N, Ohkawa S, Kamei G, Okuhara A, Shibuya H, Niimoto T, Nakasa T, Nakamae A, Deie M (2011) The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study. Arthroscopy 27:1395–1399

    Article  PubMed  Google Scholar 

  27. McConkey MO, Amendola A, Ramme AJ, Dunn WR, Flanigan DC, Britton CL, MOON Knee Group, Wolf BR (2012) Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement. Am J Sports Med 40:2737–2746

    Article  PubMed  Google Scholar 

  28. Kopf S, Martin DE, Tashman S, Fu FH (2010) Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92:871–881

    Article  PubMed  Google Scholar 

  29. Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29:567–574

    CAS  PubMed  Google Scholar 

  30. Howell SM, Taylor MA (1993) Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg Am 5:1044–1055

    Google Scholar 

  31. Sullivan JP, Matava MJ, Flanigan DC, Gao Y, Britton CL, Amendola A, MOON Group, Wolf BR (2012) Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction. Am J Sports Med 40:2236–2241

    Article  PubMed  Google Scholar 

  32. Aglietti P, Zaccherotti G, Menchetti PPM, De Biase P (1995) A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 3:2–8

    Article  CAS  PubMed  Google Scholar 

  33. Scheffel PT, Henninger HB, Burks RT (2013) Relationship of the intercondylar roof and the tibial footprint of the ACL: implications for ACL reconstruction. Am J Sports Med 41:396–401

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Orthopedic Department, Caen University Hospital, Comete INSERM U1075 – UCBN EA 3917, Avenue de la Côte de Nacre, Caen, 14033, France

    Christophe Hulet MD, Goulven Rochcongar & Valentin Chapus

Authors
  1. Christophe Hulet MD
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  2. Goulven Rochcongar
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  3. Valentin Chapus
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Editor information

Editors and Affiliations

  1. ATOS Hospital Heidelberg, Heidelberg, Germany

    Rainer Siebold

  2. Lyon Ortho Clinic, Lyon, France

    David Dejour

  3. Istituti Ortopedico Rizzoli Clinica Ortopedica Traumatologica III, Bologna, Italy

    Stefano Zaffagnini

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© 2014 ESSKA

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Hulet, C., Rochcongar, G., Chapus, V. (2014). Tibial Bone Tunnel Placement (Arthroscopically and with Fluoroscopy). In: Siebold, R., Dejour, D., Zaffagnini, S. (eds) Anterior Cruciate Ligament Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45349-6_18

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  • DOI: https://doi.org/10.1007/978-3-642-45349-6_18

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-45348-9

  • Online ISBN: 978-3-642-45349-6

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