Radiographic guided drilling of bony tibial tunnels for fixation of meniscus transplants using percentage references

Abstract

The objective of our investigation was to evaluate the precision of radiographic-guided tibial tunnel drilling for anatomical anchoring of meniscus transplants at the tibial insertion areas. In 20 cadaveric proximal tibiae, the meniscal insertions were dissected and their circumferences outlined. Standardized photographs of the tibial plateau were obtained. Applying established percentage values for radiographic determination of the meniscus insertion midpoints, tibial tunnels were drilled using a standard ACL-guide. Guide positioning was performed by using the midpoints as determined on standard AP and lateral radiographs. After tibial tunnel drilling, a second set of standardized photographs of the tibial plateau was obtained. Digital imaging permitted the superposition of pre- and postoperative images. Overlapping between the anatomical insertion areas and the tibial tunnel exit was determined, as well as the distance between the borders of the insertion areas and the tunnel exit. Insertion area and tunnel exit showed a mean overlapping of 59.8 ± 34.8% (anterior horn), respectively 62.4 ± 32.0% (posterior horn) for the lateral meniscus and of 88.4 ± 15.5% (anterior horn), respectively 60.3 ± 31.6% (posterior horn) for the medial meniscus. Mean distance between the borders of insertion area and tunnel exit was 2.0 ± 1.5 mm (anterior horn), respectively 2.0 ± 1.7 mm (posterior horn) for the lateral meniscus and 0.9 ± 0.9 mm (anterior horn), respectively 2.1 ± 1.4 mm (posterior horn) for the medial meniscus. Thus, a precise drilling of tibial tunnels at the anatomical insertions of the menisci can be obtained by positioning a standard ACL-guide under radiographic control in a cadaver setting. In advanced day-by-day clinic, this knowledge could facilitate the surgical technique for anatomical fixation of lateral and medial meniscus transplants.