Skip to main content
SpringerLink
Log in

Three dimensionalCT analysis of femoral tunnel position after ACL reconstruction. A prospective study of one hundred and thirty five cases

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

One of the principal causes for failure of anterior cruciate ligament reconstruction (ACL) is femoral tunnel mal-position. Several studies compare the position of femoral tunnels achieved with various techniques, with small series and using a quadrant assessment method.

Questions

(1) What is the incidence of anatomical positioning of the intra-articular femoral tunnel aperture in primary ACL reconstruction in a university knee surgery? (2) What are the main errors in positioning?

Methods

3D-CT scans were performed after primary ACL reconstruction in 135 consecutive cases. The intra-articular position of the femoral tunnel aperture was analyzed using the Magnussen classification.

Results

The intra-articular tunnel position was deemed anatomical in 77%, intermediate in 20.8%, and non-anatomical in 2.2%. Among the mal-positioned tunnels, 54.8% were vertical, 29% were anteriorly positioned, and 16.1% were both.

Conclusions

The intra articular femoral tunnel aperture was well positioned using an outside-in technique. The main error of tunnel positioning was a tunnel too vertical.

Level of Evidence: Level III, prospective study (case series).

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

Similar content being viewed by others

References

  1. Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F et al (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19(2):196–201

    Article  PubMed  Google Scholar 

  2. Kawakami Y, Hiranaka T, Matsumoto T, Hida Y, Fukui T, Uemoto H et al (2012) The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(8):1503–1510

    Article  PubMed  Google Scholar 

  3. Meuffels DE, Reijman M, Verhaar JA (2012) Computer-assisted surgery is not more accurate or precise than conventional arthroscopic ACL reconstruction: a prospective randomized clinical trial. J Bone Joint Surg Am 94(17):1538–1545

    Article  PubMed  Google Scholar 

  4. Musahl V, Burkart A, Debski RE, Van Scyoc A, Fu FH, Woo SL (2002) Accuracy of anterior cruciate ligament tunnel placement with an active robotic system: a cadaveric study. Arthroscopy 18(9):968–973

    Article  PubMed  Google Scholar 

  5. Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 22(2):205–214

    Article  PubMed  Google Scholar 

  6. Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH (2013) Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc 21(9):2072–2080

    Article  PubMed  Google Scholar 

  7. Zantop T, Petersen W (2008) Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique. Arch Orthop Trauma Surg 128(11):1287–1294

    Article  PubMed  Google Scholar 

  8. Magnussen RA, Debieux P, Benjamin B, Lustig S, Demey G, Servien E et al (2012) A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery. Knee Surg Sports Traumatol Arthrosc 20(7):1298–1306

    Article  PubMed  Google Scholar 

  9. Larson AI, Bullock DP, Pevny T (2012) Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. Arthroscopy 28(7):972–979

    Article  PubMed  Google Scholar 

  10. Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20(11):2200–2207

    Article  PubMed  Google Scholar 

  11. Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S et al (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(6):1418–1426

    Article  PubMed  Google Scholar 

  12. 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(11):2083–2090

    Article  PubMed  Google Scholar 

  13. Lee DH, Kim HJ, Ahn HS, Bin SI (2016) Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24(12):3713–3721

    Article  PubMed  Google Scholar 

  14. Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–21, discussion 21-12

    CAS  PubMed  Google Scholar 

  15. Basdekis G, Christel P, Anne F (2009) Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan. Knee Surg Sports Traumatol Arthrosc 17(9):1089–1094

    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(1):26–35

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hoser C, Tecklenburg K, Kuenzel KH, Fink C (2005) Postoperative evaluation of femoral tunnel position in ACL reconstruction: plain radiography versus computed tomography. Knee Surg Sports Traumatol Arthrosc 13(4):256–262

    Article  PubMed  Google Scholar 

  18. Meuffels DE, Potters JW, Koning AH, Brown CH Jr, Verhaar JA, Reijman M (2011) Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images. Acta Orthop 82(6):699–703

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dargel J, Schmidt-Wiethoff R, 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(3):220–227

    Article  PubMed  Google Scholar 

  20. Parkar AP, Adriaensen ME, Fischer-Bredenbeck C, Inderhaug E, Strand T, Assmus J et al (2015) Measurements of tunnel placements after anterior cruciate ligament reconstruction--a comparison between CT, radiographs and MRI. Knee 22(6):574–579

    Article  PubMed  Google Scholar 

  21. Kaseta MK, DeFrate LE, Charnock BL, Sullivan RT, Garrett WE Jr (2008) Reconstruction technique affects femoral tunnel placement in ACL reconstruction. Clin Orthop Relat Res 466(6):1467–1474

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pansard E, Klouche S, Vardi G, Greeff E, Hardy P, Ferguson M (2015) How accurate are anatomic landmarks for femoral tunnel positioning in anterior cruciate ligament reconstruction? An in vivo imaging analysis comparing both anteromedial portal and outside-in techniques. Arthroscopy 31(5):882–889

    Article  PubMed  Google Scholar 

  23. Yau WP, Fok AW, Yee DK (2013) Tunnel positions in transportal versus transtibial anterior cruciate ligament reconstruction: a case-control magnetic resonance imaging study. Arthroscopy 29(6):1047–1052

    Article  CAS  PubMed  Google Scholar 

  24. Osti M, Krawinkel A, Ostermann M, Hoffelner T, Benedetto KP (2015) Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 43(9):2250–2258

    Article  PubMed  Google Scholar 

  25. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23(11):1218–1225

    Article  PubMed  Google Scholar 

  26. Sbihi A, Christel P (2006) Anatomie du ligament croisé antérieur et isométrie. In: Franck A, Dorfmann H, d’arthroscopie Sf (eds) Arthroscopie: Généralités, genou, cheville, hanche, épaule, coude, poignet, extra-articulaire, 2ème edn. Elsevier, Amsterdam, pp 125–135

    Google Scholar 

  27. Robert HE, Bouguennec N, Vogeli D, Berton E, Bowen M (2013) Coverage of the anterior cruciate ligament femoral footprint using 3 different approaches in single-bundle reconstruction: a cadaveric study analyzed by 3-dimensional computed tomography. Am J Sports Med 41(10):2375–2383

    Article  PubMed  Google Scholar 

  28. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor award paper. Arthroscopy 19(3):297–304

    Article  PubMed  Google Scholar 

  29. Marchant BG, Noyes FR, Barber-Westin SD, Fleckenstein C (2010) Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am J Sports Med 38(10):1987–1996

    Article  PubMed  Google Scholar 

  30. Inderhaug E, Larsen A, Strand T, Waaler PA, Solheim E (2016) The effect of feedback from post-operative 3D CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 24(1):154–160

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre Albert Trillat, Hôpital de la Croix Rousse, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France

    Olivier Reynaud, Cécile Batailler, Sebastien Lustig & Elvire Servien

  2. Melbourne Orthopaedic Group, 33 The Avenue, Windsor, 3181, Australia

    Timothy Lording

  3. Centre Albert Trillat, 69004, Lyon, France

    Philippe Neyret

Authors
  1. Olivier Reynaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cécile Batailler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy Lording
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastien Lustig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elvire Servien
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Neyret
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cécile Batailler.

Ethics declarations

The ethical committee has approved this study (CAL n° 2016-037). Our medical practice has not been modified for this study. CT scans are performed routinely for all patients with ACL reconstruction since 2012. No additional examinations have been performed. This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

Conflict of interest statement

O.R., C.B., T.L. and E.S. declare that they have no conflict of interest.

S.L.: consultant for Smith & Nephew, institutional research support to Tornier-Wright and Amplitude.

P.N.: consultant for Smith & Nephew, institutional research and teaching support from Tornier-Wright and Amplitude, royalties from Tornier-Wright.

Additional information

Investigation performed at Albert Trillat Center, Lyon North University Hospital, Lyon, France.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reynaud, O., Batailler, C., Lording, T. et al. Three dimensionalCT analysis of femoral tunnel position after ACL reconstruction. A prospective study of one hundred and thirty five cases. International Orthopaedics (SICOT) 41, 2313–2319 (2017). https://doi.org/10.1007/s00264-017-3596-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-017-3596-x

Keywords

Search

Navigation