Abstract
The objective of this study was to evaluate the position of a K-wire drilled into the lowest and most shallow position possible in the femoral footprint of the anterior cruciate ligament (ACL) with an over-the-top drill guide and to compare this position in relation to the total length of the femoral footprint. In eight specimens, the K-wire was drilled through the guide from the medial side to mimic the anteromedial portal used during arthroscopy. The distances between the K-wire and the farthest points of the anteromedial (AM) and posterolateral (PL) end of the ACL footprint were measured. The median ACL footprint was 15 mm (range 14–18). The median distance from the K-wire was 5 mm (range 3–8) to the AM end of the footprint and 10 mm (range 9–15) to the PL end of the footprint. The K-wire did not reach the middle of the ACL footprint length in any of the specimens. The posterior border of the articular cartilage on the lateral femoral condyle prevented the drill guide from being placed in a lower and more shallow position. The results of this study showed that a tunnel drilled using an over-the-top drill guide and placed in the lowest and most shallow position possible within the ACL footprint is almost exclusively situated in the AM bundle origin.
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Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199
Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts. An in vivo study comparing tibial internal-external rotation. Am J Sports Med 35:189–196
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
Dargel J, Wiethoff RS, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227
Friederich NF, OBrien WR (1992) Functional anatomy of the cruciate ligaments. In: Jakob RP, Stäubli H-U (eds) The knee and the cruciate ligaments. Springer, Berlin, pp 80–94
Fu FH, Bennet CH, Ma CB, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med 28:124–130
Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89
Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256
Harner CD, Honkamp NJ, Ranawat AS (2008) Anteromedial portal technique for creating the anterior cruiciate ligament femoral tunnel. Arthroscopy 24:113–115
Howell SM, Wallace MP, Hull ML, Deutsch ML (1999) Evaluation of the single-incision arthroscopic technique for anterior cruciate ligament replacement. A study of tibial tunnel placement, intraoperative graft tension, and stability. Am J Sports Med 27:284–293
Jepsen CF, Lundberg-Jensen AK, Faunoe P (2007) Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy 23:1326–1333
Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913
Kilger RH, Thomas M, Hanford S, Alaseirlis DA, Paessler HH, Woo SL (2005) The effectiveness of reconstruction of the anterior cruciate ligament using the novel knot/press-fit technique. Am J Sports Med 33:856–863
Logan MC, Williams A, Lavelle J, Gedroyc W, Freeman M (2004) Tibiofemoral kinematics following successful anterior cruciate ligament reconstruction using dynamic multiple resonance imaging. Am J Sports Med 32:984–992
Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SLY (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304
Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361
Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262
Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res. 454:35–47
Rue JP, Ghodadra N, Bach BR (2008) Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament. Am J Sports Med 36:73–79
Shelbourne KD, Klootwyk TE (1993) The miniarthrotomy technique for anterior cruciate ligament reconstruction. Op Tech Sports Med. 1:26–39
Siebold R, Fu FH (2008) Assessment and augmentation of symptomatic anteromedial or posterolateral bundle tears of the anterior cruciate ligament. Arthroscopy 24:1289–1298
Steiner ME (2009) Independent drilling of tibial and femoral tunnels in anterior cruciate ligament reconstruction. J Knee Surg 22:171–176
Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983
Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025
Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparison among 3 different procedures. Arthroscopy 22:240–251
Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 36:678–685
Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–999
Zantop T, Wellmann M, Fu FH, Petersen 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
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Behrendt, S., Richter, J. Anterior cruciate ligament reconstruction: drilling a femoral posterolateral tunnel cannot be accomplished using an over-the-top step-off drill guide. Knee Surg Sports Traumatol Arthrosc 18, 1252–1256 (2010). https://doi.org/10.1007/s00167-010-1112-6
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DOI: https://doi.org/10.1007/s00167-010-1112-6