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3D CT Evaluation Of Tunnel Positioning In ACL Reconstruction Using The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique
ESSKA Academy. Saithna A. May 12, 2018; 218166
Prof. Adnan Saithna
Prof. Adnan Saithna
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Abstract
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Objectives: Remnant preservation may confer important advantages in the ACL reconstructed knee. However, the presence of a large remnant may obscure visualisation and impair the ability to correctly place tunnels. The purpose of this study was to determine whether tunnel placement during anatomic ACL reconstruction using The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique is consistent and precise when a large native remnant is preserved.

Methods: 99 consecutive patients undergoing an ACL reconstruction during which at least 50% of the native ACL was preserved, were included in this prospective study. The femoral tunnel was created using an outside-in specific guide. The tibial tunnel, was positioned in the anteromedial region of the ACL footprint and the remnant was carefully preserved while drilling and passing the semitendinosus graft through it. Post-operatively, 3D-CT was used to evaluate tunnel placement. The mean tunnel locations were calculated and the standard deviation was used to evaluate precision of positioning. Inter- and intra-reader agreement was determined to assess reliability of evaluation of tunnel position.

Results: The centre of the femoral tunnel was positioned at a mean of 19.4 % (SD 2 %) of the depth of the notch and a mean of 23.1% (SD 3,5%) of the lateral wall height. The centre of the tibial tunnel was positioned at a mean of 36.3 % (SD 3.8 %) of the anteroposterior length of the tibial plateau and at a mean of 47 % (SD 2.6 %,) from medial to lateral. The small standard deviations demonstrate that this technique allows precise tunnel placement. The tunnel positions achieved were consistent with previous anatomic studies of femoral and tibial anteromedial bundle insertion. Intra-observer and inter-observer reliability was high.

Conclusions: 3D CT evaluation demonstrates that despite the presence of a large remnant, placement of femoral and tibial tunnels for anatomic ACL reconstruction using the SAMBBA technique is consistent and precise. It is concluded that concerns regarding suboptimal visualisation for tunnel placement, if a large native ACL remnant is preserved, are not valid and that precise positioning of tunnels can be reliably achieved.

Keywords:
ACL, remnant preservation, SAMBBA, tunnel position
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