Skip to main content
SpringerLink
Log in

Anteromedial versus central single-bundle graft position: which anatomic graft position to choose?

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

Abstract

Purpose

To compare the time-zero stability of an anatomic anteromedial (AM) single-bundle ACL reconstruction to an anatomic central (CTR) single-bundle ACL reconstruction.

Methods

Twelve (6 paired) hip to knee cadaveric specimens were studied. Using custom ACL computer navigation software, a Lachman test and a previously validated, navigated mechanized pivot shift test were performed on 4 separate experimental groups in each specimen: (1) intact ACL, (2) ACL deficient with total medial and lateral meniscectomy, (3) following anatomic AM single-bundle ACL reconstruction, and (4) after anatomic CTR single-bundle ACL reconstruction. Maximum anterior tibial translation in each group was measured.

Results

Lachman: No significant difference was observed between the AM and CTR reconstructions (n.s.) or between reconstruction and the intact ACL (3.4 ± 1.7 mm) (n.s.). Pivot Shift: Both the AM and CTR ACL reconstructions significantly reduced anterior translation relative to the ACL/menisci-deficient condition (lateral compartment: 8.9 ± 3.8 mm and 6.75 ± 4.6 mm vs. 17.25 ± 3.5 mm, respectively; P < 0.001 and medial compartment: −3.0 ± 5.3 mm vs. −3.7 ± 5.7 mm vs. 6.2 ± 6.7 mm, P < 0.05). There was also a significant difference between the AM (P < 0.001) and CTR (P < 0.05) ACL reconstructions and the intact ACL (2.8 ± 4.4 mm) for lateral compartment translation. Further, no difference was found between lateral or medial compartment translations in the AM versus CTR reconstructions (n.s.).

Conclusions

It has been shown that there was no difference in the time-zero biomechanical stability between an anatomic anteromedial and anatomic central single-bundle ACL reconstruction. Given the current debate on the best anatomic ACL reconstruction technique, anatomic socket position in either the anteromedial or central locations provides similar time-zero biomechanics.

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

Similar content being viewed by others

References

  1. Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol 18:1269–1276

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Brophy RH, Voos JE, Shannon FJ et al (2008) Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of single-bundle reconstruction and native anterior cruciate ligament. Am J Sports Med 36:2196–2203

    Article  PubMed  Google Scholar 

  4. Cohen SB, VanBeek C, Starman JS, Armfield D, Irrgang JJ, Fu FH (2009) MRI measurement of the 2 bundles of the normal anterior cruciate ligament. Orthopedics 32:687

    Article  Google Scholar 

  5. Donaldson WF III, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med 13:5–10

    Article  PubMed  Google Scholar 

  6. Ferretti A, Monaco E, Labianca L, De Carli A, Maestri B, Conteduca F (2009) Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation. Am J Sports Med 37:1548–1553

    Article  PubMed  Google Scholar 

  7. Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Google Scholar 

  9. Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195

    PubMed  Google Scholar 

  10. Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and nonanatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617

    Article  PubMed  Google Scholar 

  11. Kato Y, Ingham SJ, Kramer S, Smolinski P, Saito A, Fu FH (2010) Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 18:2–10

    Article  PubMed  Google Scholar 

  12. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  PubMed  Google Scholar 

  13. Koh J (2005) Computer-assisted navigation and anterior cruciate ligament reconstruction: accuracy and outcomes. Orthopedics 28:s1283–s1287

    PubMed  Google Scholar 

  14. 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 

  15. Lucie RS, Wiedel JD, Messner DG (1984) The acute pivot shift: clinical correlation. Am J Sports Med 12:189–191

    Article  PubMed  CAS  Google Scholar 

  16. Maak TG, Bedi A, Raphael BS, Citak M, Suero E, Wickiewicz T, Pearle AD (2011) Effect of femoral socket position on graft impingement after anterior cruciate ligament reconstruction. Am J Sports Med 39:1018–1023

    Article  PubMed  Google Scholar 

  17. Matsumoto H (1990) Mechanism of the pivot shift. J Bone Jt Surg Br 72-B(5):816–821

    Google Scholar 

  18. Miller MD, Gerdeman AC, Miller CD, Hart JM, Gaskin CM, Golish SR, Clancy WG Jr (2010) The effects of extra-articular starting point and tarsotibial femoral drilling on the intra-articular aperture of the tibial tunnel in ACL reconstruction. Am J Sports Med 38:707–712

    Article  PubMed  Google Scholar 

  19. Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD (2010) Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 38:918–923

    Article  PubMed  Google Scholar 

  20. Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18:1232–1238

    Article  PubMed  Google Scholar 

  21. 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 

  22. Robinson J, Stanford FC, Kendoff D, Stüber V, Pearle AD (2009) Replication of the range of native anterior cruciate ligament fiber length change behavior achieved by different grafts: measurement using computer-assisted navigation. Am J Sports Med 37:1406–1411

    Article  PubMed  Google Scholar 

  23. 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 Jt Surg Am 72:259–267

    CAS  Google Scholar 

  24. van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258–268

    Article  PubMed  Google Scholar 

  25. Voos JE, Musahl V, Maak TG, Wickiewicz TL, Pearle AD (2010) Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc 18:1282–1289

    Article  PubMed  Google Scholar 

  26. Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685

    Article  PubMed  Google Scholar 

  27. 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 

Download references

Acknowledgments

Specimens were provided by Praxim, Inc. The study was partially funded by the Eduardo Salvati Resident Research Grant.

Author information

Authors and Affiliations

  1. Computer Assisted Surgery Laboratory, Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA

    Michael B. Cross, Sommer Hammoud, Eduardo Suero & Andrew D. Pearle

  2. Department of Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Volker Musahl

  3. Department of Sports Medicine, University of Michigan, Ann Arbor, MI, USA

    Asheesh Bedi

  4. Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland

    Padhraig O’Loughlin

Authors
  1. Michael B. Cross
    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. Asheesh Bedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Padhraig O’Loughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sommer Hammoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eduardo Suero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew D. Pearle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael B. Cross.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cross, M.B., Musahl, V., Bedi, A. et al. Anteromedial versus central single-bundle graft position: which anatomic graft position to choose?. Knee Surg Sports Traumatol Arthrosc 20, 1276–1281 (2012). https://doi.org/10.1007/s00167-011-1737-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-011-1737-0

Keywords

Search

Navigation