Ideal femoral tunnel placement in the single bundle remnant-preserving anterior cruciate ligament reconstruction using a posterior trans-septal portal
Author(s):
Lee S. (South Korea (ROK))
,
Lee S. (South Korea (ROK))
Affiliations:
Lee Y.
,
Lee Y.
Affiliations:
Lee O.
,
Lee O.
Affiliations:
Jo I.
,
Jo I.
Affiliations:
Seo J.
Seo J.
Affiliations:
ESSKA Academy. Lee S. 05/09/18; 209470; P06-768 Topic: Sports Related Injuries
Dr. Seung Hoon Lee
Dr. Seung Hoon Lee
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Abstract
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Objectives: Anatomic tunnel formation and remnant preservation are valuable aspects in anterior cruciate ligament (ACL) reconstruction. However, anatomic landmarks are difficult to observe during remnant-preserving ACL reconstruction, especially if anterior arthroscopic viewing is used. In addition, the stress pattern of the reconstructed ACL in the femoral tunnel aperture is different compared with native ACL. The hypotheses of this study were that 1) the apex of the deep cartilage margin (ADC) that is observed using a posterior arthroscopic viewing would be a good landmark for the remnant-preserving ACL reconstruction and that 2) the proximal position of the femoral tunnel would provide better stability compared to the tunnel produced in the footprint center.

Methods: A total of 109 patients were included in this study and the femoral tunnel was formed at the most proximal corner of the femoral footprint using a posterior trans-septal (TS) portal. All patients underwent immediate postoperative computed tomography (CT) scans. The distance from the tunnel center to the ADC was measured in the CT scans and arthroscopic viewing. After then, two measurement methods were compared. Finally, femoral tunnel location was compared to the anatomic reference data and was correlated with outcomes. Paired T-test was used to compare femoral tunnel position and bivariate correlation analysis was used to evaluate relationship between femoral tunnel position and outcomes.

Results: The femoral tunnel center was placed at a more proximal position using the TS portal and ADC as a reference compared to the center of the reference data. The average distance from the ADC to the femoral tunnel center was 7.0 mm ± 1.4 mm as measured by arthroscopic viewing and 7.2 mm ± 2.0 mm as measured using 3-D CT. No statistically significant difference (p=0.420) was found between the two methods. Clinical outcome was not related to the femoral tunnel location; however, stability outcome was related to the femoral tunnel location, and more proximally located femoral tunnels showed better stability.

Conclusions: ADC can be a possible landmark in the remnant-preserving ACL reconstruction using a posterior TS portal. A more proximal femoral tunnel that is located at the proximal corner of the ACL remnant can provide advantage in terms of the stability during the remnant-preserving ACL reconstruction.

Keywords:
Anterior cruciate ligament, Femoral tunnel, Anatomic location, Landmark, Stability
Objectives: Anatomic tunnel formation and remnant preservation are valuable aspects in anterior cruciate ligament (ACL) reconstruction. However, anatomic landmarks are difficult to observe during remnant-preserving ACL reconstruction, especially if anterior arthroscopic viewing is used. In addition, the stress pattern of the reconstructed ACL in the femoral tunnel aperture is different compared with native ACL. The hypotheses of this study were that 1) the apex of the deep cartilage margin (ADC) that is observed using a posterior arthroscopic viewing would be a good landmark for the remnant-preserving ACL reconstruction and that 2) the proximal position of the femoral tunnel would provide better stability compared to the tunnel produced in the footprint center.

Methods: A total of 109 patients were included in this study and the femoral tunnel was formed at the most proximal corner of the femoral footprint using a posterior trans-septal (TS) portal. All patients underwent immediate postoperative computed tomography (CT) scans. The distance from the tunnel center to the ADC was measured in the CT scans and arthroscopic viewing. After then, two measurement methods were compared. Finally, femoral tunnel location was compared to the anatomic reference data and was correlated with outcomes. Paired T-test was used to compare femoral tunnel position and bivariate correlation analysis was used to evaluate relationship between femoral tunnel position and outcomes.

Results: The femoral tunnel center was placed at a more proximal position using the TS portal and ADC as a reference compared to the center of the reference data. The average distance from the ADC to the femoral tunnel center was 7.0 mm ± 1.4 mm as measured by arthroscopic viewing and 7.2 mm ± 2.0 mm as measured using 3-D CT. No statistically significant difference (p=0.420) was found between the two methods. Clinical outcome was not related to the femoral tunnel location; however, stability outcome was related to the femoral tunnel location, and more proximally located femoral tunnels showed better stability.

Conclusions: ADC can be a possible landmark in the remnant-preserving ACL reconstruction using a posterior TS portal. A more proximal femoral tunnel that is located at the proximal corner of the ACL remnant can provide advantage in terms of the stability during the remnant-preserving ACL reconstruction.

Keywords:
Anterior cruciate ligament, Femoral tunnel, Anatomic location, Landmark, Stability
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