Femoral Tunnel Three Approach Comparison for Double Bundle Anterior Cruciate Ligament Reconstruction
Asian Journal of Orthopaedic Research,
Background: There is a lot of controversy surrounding the technique of femoral tunnel placement during reconstruction of anterior cruciate ligament. By our study we attempt to clarify the controversy by using three different techniques for femoral tunnel position with the same concept of tunnel creation and supported measurement data.
Methods: The creation of the femoral tunnel placement of double bundle ACL reconstruction was carried out using the behind remnant approach. The Transtibial approach was carried out for all primary Anterior Cruciate Ligament injury cases till December 2017. After that, from January 2018 to September 2018 we used the Trans-portal approach followed by which the Outside In approach was used from October 2018 to March 2019. We compared the tunnel position with a 3D reconstructed computer tomography image. We also analyzed through our study the length of each femoral tunnel and the distance between septum of every anteromedial and posterolateral tunnel.
Results: The aperture of the anteromedial bundle tunnel position in Transtibial method was higher and shallow as compared to that Trans-portal method. Also, the tunnel length in Trans-portal was shorter as compared to the Transtibial method and the Outside In approach.
Conclusion: There is a risk of antero-medial aperture position in Transtibial approach being high and shallow, whereas Trans-portal approach runs the risk of short tunnel length. Hence, we could conclude that it is important to apply any of the methods flexibly to each case as there is no data supporting a single best approach.
- Femoral tunnel
- outside in
- anterior cruciate ligament reconstruction.
How to Cite
Kawaguchi Y, Kondo E, Kitamura N, Kai S, Inoue M, Yasuda K. Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1249e57.
Muneta T, Yamamoto H, Sakai H, Ishibashi T, Furuya K. Relationship between changes in length and force in In vitro reconstructed anterior cruciate ligament. Am J Sports Med. 1993;21(2): 299e304.
Shino K, Nakata K, Nakamura N, Toritsuka Y, Horibe S, Nakagawa S, et al. Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy. 2008; 24(10):1178e83.
Van Eck CF, Martins CA, Kopf S, Lertwanich P, Fu FH, Tashman S. Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study. Arthroscopy. 2011;27(2):207e12.
Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, et al. Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy. 2004;20(10):1015e25.
Desai N, Bj€ornsson H, Musahl V, Bhandari M, Petzold M, Fu FH, et al. Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2014; 22(5):1009e23.
Clevio Desouza, Girish Nathani, Bhamare DS, Ishan Shevate. Functional results after anterior cruciate ligament reconstruction using the bone-patella tendon-bone method. International Journal of Orthopaedics Sciences. 2019;5(4):483-485.
Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy. 2007;23(6):618e28.
Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, et al. Effect of femoral tunnel position on graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22(11):2811e20.
Sommer C, Friederich NF, Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):207e13.
Carson EW, Anisko EM, Restrepo C, Panariello RA, O'Brien SJ, Warren RF. Revision anterior cruciate ligament reconstruction: Etiology of failures and clinical results. J Knee Surg. 2004;17(3): 127e32.
Kamath GV, Redfern JC, Greis PE, Burks RT. Revision anterior cruciate ligament reconstruction. Am J Sports Med. 2011; 39(1):199e217.
Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10(1):14e21. Discussion 21-22.
Inoue M, Tokuyasu S, Kuwahara S, Yasojima N, Kasahara Y, Kondo E, et al. Tunnel location in transparent 3-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique. Knee Surg Sports Traumatol Arthrosc. 2010;18(9):1176e83.
Kerner S, Etienne D, Malet J, Mora F, Monnet-Corti V, Bouchard P. Root coverage assessment: validity and reproducibility of an image analysis system. J Clin Periodontol. 2007;34(11): 969e76.
Horie M, Muneta T, Yamazaki J, Nakamura T, Koga H, Watanabe T, et al. A modified quadrant method for describing the femoral tunnel aperture positions in ACL reconstruction using two-view plain radiographs. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):981e5.
Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci. 2008;13(2):122e9.
Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE. Knee stability and graft function after anterior cruciate ligament reconstruction: A comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med. 2004;32(8):1825e32.
Kambara S, Nakayama H, Yamaguchi M, Matsumoto A, Sasaki K, Kashiwa K, et al. Comparison of transportal and outside-in techniques for posterolateral femoral tunnel drilling in double-bundle ACL reconstruction-three-dimensional CT analysis of bone tunnel geometry. J Orthop Sci. 2017;22(3):481e7.
Tomihara T, Hashimoto Y, Taniuchi M, Shimada N. Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study. Arch Orthop Trauma Surg. 2015;135(6):839e46.
Takeda Y, Iwame T, Takasago T, Kondo K, Goto T, Fujii K, et al. Comparison of tunnel orientation between transtibial and anteromedial portal techniques for anatomic double-bundle anterior cruciate ligament reconstruction using 3-dimensional computed tomography. Arthroscopy. 2013;29(2):195e204.
Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med. 2004;32(8):1825e32.
Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, et al. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy. 2006;22(9):984e92.
Sasaki N, Ishibashi Y, Tsuda E, Yamamoto Y, Maeda S, Mizukami H, et al. The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy. 2012;28(8):1135e46.
Tomihara T, Hashimoto Y, Taniuchi M, Shimada N. Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study. Arch Ortho Trauma Surg. 2015;135(6):839e46.
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