Skip to main content
SpringerLink
Log in

Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Recurrent rotational instability has been identified as a potential source of failure of anterior cruciate ligament (ACL) reconstructions. The aim of the study was to assess whether knee kinematics in the horizontal configuration more closely resemble the intact knee when compared with other single-bundle configurations. Using the Praxim computer navigation system, ACL reconstructions were performed with tibialis anterior grafts in six fresh-frozen whole lower extremity cadaver specimens (12 knees). In each knee, all four reconstruction configurations: conventional (PL tibia to AM femur), anteromedial (AM), posterolateral (PL), and horizontal (AM tibia to PL femur) were performed. Standardized Lachman and pivot shift examinations were performed. For all graft positions during the pivot shift, decreases in the amount of ATT were observed compared with the ACL-deficient state. The knees with grafts placed in the anterior tibial footprint (AM and horizontal) had less ATT with the Lachman and pivot shift maneuvers than knees with grafts placed in the posterior tibial footprint (PL and conventional). A significant difference in depth of impingement was noted only between the AM position and the PL position. Single-bundle ACL reconstructions using graft placement within the anterior footprint on the tibia may reduce rotational instability when compared with more vertical configurations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5–8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144

    Article  CAS  PubMed  Google Scholar 

  2. Ahn JH, Lee SH, Yoo JC, Ha HC (2007) Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study. Knee Surg Sports Traumatol Arthrosc 15:1293–1300

    Article  PubMed  Google Scholar 

  3. Ayerza MA, Muscolo DL, Costa-Paz M, Makino A, Rondon L (2003) Comparison of sagittal obliquity of the reconstructed anterior cruciate ligament with native anterior cruciate ligament using magnetic resonance imaging. Arthroscopy 19:257–261

    Article  PubMed  Google Scholar 

  4. Brophy RH, Pearle AD (2009) Single bundle ACL reconstruction: a comparison of conventional, central and horizontal single bundle virtual graft positions. Am J Sports Med 37:1317–1323

    Article  PubMed  Google Scholar 

  5. Brophy RH, Voos JE, Shannon FJ, Granchi CC, Wickiewicz TL, Warren RF, Pearle AD (2008) Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament. Am J Sports Med 36:2196–2203

    Article  PubMed  Google Scholar 

  6. Bull AM, Earnshaw PH, Smith A, Katchburian MV, Hassan AN, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 84:1075–1081

    Article  CAS  PubMed  Google Scholar 

  7. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65

    Article  PubMed  Google Scholar 

  8. Georgoulis AD, Ristanis S, Chouliaras V, Moraiti C, Stergiou N (2007) Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res 454:89–94

    Article  PubMed  Google Scholar 

  9. Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 21:791–803

    Article  PubMed  Google Scholar 

  10. Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S49–S55

    Article  PubMed  Google Scholar 

  11. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114

    Article  CAS  PubMed  Google Scholar 

  12. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84:1560–1572

    PubMed  Google Scholar 

  13. Kubo S, Muratsu H, Yoshiya S, Mizuno K, Kurosaka M (2007) Reliability and usefulness of a new in vivo measurement system of the pivot shift. Clin Orthop Relat Res 454:54–58

    Article  PubMed  Google Scholar 

  14. Lane CG, Warren R, Pearle AD (2008) The pivot shift. J Am Acad Orthop Surg 16:679–688

    PubMed  Google Scholar 

  15. Lane CG, Warren RF, Stanford FC, Kendoff D, Pearle AD (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 16:487–492

    Article  PubMed  Google Scholar 

  16. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability, graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock, 10 o’clock femoral tunnel placement: 2002 Richard O’Connor Award paper. Arthroscopy 19:297–304

    Article  PubMed  Google Scholar 

  17. Markolf KL, Park S, Jackson SR, McAllister DR (2008) Simulated pivot-shift testing with single and double-bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am 90:1681–1689

    Article  PubMed  Google Scholar 

  18. 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 

  19. Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718

    Article  PubMed  Google Scholar 

  20. Musahl V, Voos J, O’Loughlin P, Stueber V, Kendoff D, Pearle AD (2009) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc

  21. Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155

    Article  CAS  PubMed  Google Scholar 

  22. Otero AL, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9:143–148

    Article  CAS  PubMed  Google Scholar 

  23. Pearle AD, Kendoff D, Musahl V (2009) Perspectives on computer-assisted orthopaedic surgery: movement toward quantitative orthopaedic surgery. J Bone Joint Surg Am 91(Suppl 1):7–12

    Article  PubMed  Google Scholar 

  24. Pearle AD, Shannon FJ, Granchi C, Wickiewicz TL, Warren RF (2008) Comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation. Am J Sports Med 36:1534–1541

    Article  PubMed  Google Scholar 

  25. Pearle AD, Solomon DJ, Wanich T, Moreau-Gaudry A, Granchi CC, Wickiewicz TL, Warren RF (2007) Reliability of navigated knee stability examination: a cadaveric evaluation. Am J Sports Med 35:1315–1320

    Article  PubMed  Google Scholar 

  26. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293

    Article  CAS  PubMed  Google Scholar 

  27. Sapega AA, Moyer RA, Schneck C, Komalahiranya N (1990) Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. J Bone Joint Surg Am 72:259–267

    CAS  PubMed  Google Scholar 

  28. Stanford FC, Kendoff D, Warren RF, Pearle AD (2009) Native anterior cruciate ligament obliquity versus anterior cruciate ligament graft obliquity: an observational study using navigated measurements. Am J Sports Med 37:114–119

    Article  PubMed  Google Scholar 

  29. Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146

    Article  CAS  PubMed  Google Scholar 

  30. Stevenson WW 3rd, Johnson DL (2007) ‘Vertical grafts’: a common reason for functional failure after ACL reconstruction. Orthopedics 30:206–209

    PubMed  Google Scholar 

  31. Van Damme G, Defoort K, Ducoulombier Y, Van Glabbeek F, Bellemans J, Victor J (2005) What should the surgeon aim for when performing computer-assisted total knee arthroplasty? J Bone Joint Surg Am 87(Suppl 2):52–58

    Article  PubMed  Google Scholar 

  32. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  33. 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 14:982–992

    Article  PubMed  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. Zavras TD, Race A, Bull AM, Amis AA (2001) A comparative study of ‘isometric’ points for anterior cruciate ligament graft attachment. Knee Surg Sports Traumatol Arthrosc 9:28–33

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Padhraig O’Loughlin MD and Daniel Choi for their assistance with data analysis and contributions to the study.

Conflict of interest statement

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements.) that might pose a conflict of interest in connection with the submitted article.

Author information

Authors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    James E. Voos, Volker Musahl, Travis G. Maak, Thomas L. Wickiewicz & Andrew D. Pearle

Authors
  1. James E. Voos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Travis G. Maak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas L. Wickiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew D. Pearle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew D. Pearle.

Additional information

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

Rights and permissions

Reprints and permissions

About this article

Cite this article

Voos, J.E., Musahl, V., Maak, T.G. et al. Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc 18, 1282–1289 (2010). https://doi.org/10.1007/s00167-010-1162-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1162-9

Keywords

Search

Navigation