In Vivo Three-Dimensional Imaging Analysis of Femoral and Tibial Tunnel Locations in Single and Double Bundle Anterior Cruciate Ligament Reconstructions

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Abstract

Background

Anatomic footprint restoration of anterior cruciate ligament (ACL) is recommended during reconstruction surgery. The purpose of this study was to compare and analyze the femoral and tibial tunnel positions of transtibial single bundle (SB) and transportal double bundle (DB) ACL reconstruction using three-dimensional computed tomography (3D-CT).

Methods

In this study, 26 patients who underwent transtibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft. 3D-CTs were taken within 1 week after the operation. The obtained digital images were then imported into the commercial package Geomagic Studio v10.0. The femoral tunnel positions were evaluated using the quadrant method. The mean, standard deviation, standard error, minimum, maximum, and 95% confidence interval values were determined for each measurement.

Results

The femoral tunnel for the SB technique was located 35.07% ± 5.33% in depth and 16.62% ± 4.99% in height. The anteromedial (AM) and posterolateral (PL) tunnel of DB technique was located 30.48% ± 5.02% in depth, 17.12% ± 5.84% in height and 34.76% ± 5.87% in depth, 45.55% ± 6.88% in height, respectively. The tibial tunnel with the SB technique was located 45.43% ± 4.81% from the anterior margin and 47.62% ± 2.51% from the medial tibial articular margin. The AM and PL tunnel of the DB technique was located 33.76% ± 7.83% from the anterior margin, 45.56% ± 2.71% from the medial tibial articular margin and 53.19% ± 3.74% from the anterior margin, 46.00% ± 2.48% from the medial tibial articular margin, respectively. The tibial tunnel position with the transtibial SB technique was located between the AM and PL tunnel positions formed with the transportal DB technique.

Conclusions

Using the 3D-CT measuring method, the location of the tibia tunnel was between the AM and PL footprints, but the center of the femoral tunnel was at more shallow position from the AM bundle footprint when ACL reconstruction was performed by the transtibial SB technique.

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Most cited references 27

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Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.

J Lysholm, J Gillquist (2015)

We have designed a scoring scale for knee ligament surgery follow-up emphasizing evaluation of symptoms of instability. Instability is defined as "giving way" during activity. Our scoring scale was compared to a slightly modified Larson scale in patients with anteromedial and/or anterolateral instability, posterolateral and straight posterior instability, chondromalacia patellae, and meniscus lesion. The two scales gave basically the same results in patients with meniscus rupture. In patients with unstable knees, the new scale gave a significantly lower total score. Thus, the new scale evaluates functional impairment due to clinical instability better than the modified Larson scale. The total score, with the new scoring scale, corresponded to the patients' own opinion of function and to the presence or absence of signs of instability.

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Evaluation of knee ligament injuries with the IKDC form.

Christoph Müller, Roland P Jakob, F. Hefti … (1992)

Various scoring systems have been proposed to quantify the disability caused by knee ligament injuries and to evaluate the results of treatment. None of these systems has found worldwide acceptance, mainly because all scoring systems attribute numerical values to factors that are not quantifiable, and then the arbitrary scores are added together for parameters not comparable with each other. For these reasons a group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee (IKDC). A common terminology and an evaluation form was created. This form is the standard form for all publications on results of treatment of knee ligament injuries. It is a concise one-page form. It includes a documentation section, a qualification section and a evaluation section. For evaluation there are four problem areas (subjective assessment, symptoms, range of motion and ligament examination). These are supplemented with four additional areas that are only documented but not included in the evaluation (compartmental findings, donor site pathology, X-ray findings and functional tests). The form can be used pre- and post-operatively and at follow-up. It has been specified that in any publication the minimum follow-up time for short-term results should be 2 years, for medium-term results 5 years and for long-term results 10 years. The largest part of the sheet is the qualification section. It is called "qualification" section rather than "scoring" section because no scores are given. Each parameter is qualified as "normal", "nearly normal", "abnormal" or "severely abnormal". This qualification is less subjective and emotional than "very good", "good", "fair" and "poor".(ABSTRACT TRUNCATED AT 250 WORDS)

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Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study.

Max Ekdahl, F Fu, Mario Ferretti … (2007)

Anatomic tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine qualitatively and quantitatively the osseous landmarks of femoral attachment of the ACL. The femoral attachment of the ACL was studied histologically in seven human fetuses, arthroscopically in 60 patients who underwent ACL surgery, and grossly in 16 cadaveric knees. Three-dimensional laser digitizer pictures of the cadaveric specimens were taken to quantify length, area, and angulations of the femoral attachment of the ACL. Two different osseous landmarks were detected. An osseous ridge that runs from proximal to distal ends was present in all the arthroscopic patients and cadaveric knees. It was named "lateral intercondylar ridge." Another osseous landmark between the femoral attachment of the anteromedial (AM) and posterolateral (PL) bundles running from anterior to posterior was observed in 6 out of 7 fetuses, 49 out of 60 arthroscopic patients, and 13 out of 16 cadaveric knees. It was named "lateral bifurcate ridge." A change of slope between the femoral attachment of the AM and PL bundles was observed in all specimens studied. The femoral attachment of the AM bundle formed an angle with the PL bundle of 27.6 degrees +/- 8.8 degrees and a radius of curvature of 25.7 +/- 12 mm. The area of the entire ACL footprint, AM, and PL bundle was 196.8 +/- 23.1 mm(2), 120 +/- 19 mm(2), and 76.8 +/- 15 mm(2), respectively. The ACL femoral attachment has a unique topography with a constant presence of the lateral intercondylar ridge and often an osseous ridge between AM and PL femoral attachment, the lateral bifurcate ridge. These findings may assist surgeons to perform ACL surgery in a more anatomic fashion.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Orthop Surg

Journal ID (iso-abbrev): Clin Orthop Surg

Journal ID (publisher-id): CIOS

Title: Clinics in Orthopedic Surgery

Publisher: The Korean Orthopaedic Association

ISSN (Print): 2005-291X

ISSN (Electronic): 2005-4408

Publication date (Print): March 2014

Publication date (Electronic): 14 February 2014

Volume: 6

Issue: 1

Pages: 32-42

Affiliations

Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.

[* ]Department of Mechanical Engineering, Korea University, Seoul, Korea.

[† ]Catholic Institute for Applied Anatomy, The Catholic University of Korea College of Medicine, Seoul, Korea.

[‡ ]Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Author notes

Correspondence to: Joon Ho Wang, MD. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-4310-3507, Fax: +82-2-3410-0061, mdwang88@ 123456gmail.com

Article

DOI: 10.4055/cios.2014.6.1.32

PMC ID: 3942600

PubMed ID: 24605187

SO-VID: 08ce0a0c-5411-4e3a-8f5d-2436fe923c57

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

In Vivo Three-Dimensional Imaging Analysis of Femoral and Tibial Tunnel Locations in Single and Double Bundle Anterior Cruciate Ligament Reconstructions

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Abstract

Background

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Conclusions

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25th European Students' Conference

Most cited references 27

Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.

Evaluation of knee ligament injuries with the IKDC form.

Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study.

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