An Analysis of the Femoral Drilling Angle to Avoid Tunnel Collision during Double-Bundle Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction on the Knee

Kawanishi, Yusuke; Kobayashi, Makoto; Yasuma, Sanshiro; Fukushima, Hiroaki; Katō, Jirō; Murase, Atsunori; Takenaga, Tetsuya; Yoshida, Masahito; Kuroyanagi, Gen; Kawaguchi, Yohei; Waguri-Nagaya, Yuko; Murakami, Hideki; Nozaki, Masahiro

doi:10.1055/s-0041-1736196

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…In this study, the drilling orientation of the femoral tunnel was an independent variable. The angle combination method was applied by referring to two planes and speciic anatomical landmarks to measure and describe the tunnel orientations [14,33,34]. After palpation and observation, two markers were inserted at each epicondyle of the femur to outline the transepicondylar axis [35], and the line parallel to the transepicondylar axis served as the 0° reference angulation in the axial plane.…”

Section: Exploring the Correlation Between Tunnel Orientation And The...mentioning

confidence: 99%

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Guo

Zhang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the relationship between the medial and posteromedial femoral anatomic structures and the femoral tunnel exit produced by different tunnel orientations when creating the femoral tunnel for posterior cruciate ligament reconstruction (PCLR) using the inside‐out (IO) technique and to estimate safe tunnel orientations to minimize the risk of iatrogenic injury to these structures. MethodsEleven cadaveric knees were used. The medial and posteromedial aspects of each knee joint were dissected to reveal the "safe zone," which is a bony area that avoids the distribution or attachment of at‐risk structures (MCL, PMC structures, and articular cartilage), while remaining 10 mm away from the articular cartilage. The hypothesis of this study was that by creating the femoral tunnel at specific angles using the IO technique, the tunnel outlet would be as close to the safe zone as possible, protecting the at‐risk structures from damage. Femoral tunnels were drilled at 20 different angle combinations on each specimen: 0°, 15°, 30°, 45°, and 60° relative to a line parallel to the transepicondylar axis in the axial plane, as well as 15°, 30°, 45°, and 60° relative to a line parallel to the femoral axis in the coronal plane. The positional relationship between each tunnel exit and the safe zone was recorded, and the shortest distance between the exit center and the safe zone boundary was measured. ResultsThe risk of iatrogenic injury differed depending on the drilling orientation (χ2 = 168.880, P < 0.001). Femoral drilling angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/coronal) were considered relatively safer than other orientations (P < 0.05). The shortest distance between the tunnel exit and the safe zone boundary was negatively correlated with the angle in the axial plane (P < 0.001, r = − 0.810). ConclusionsWhen creating the IO femoral tunnel for single‐bundle PCL reconstruction, angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/oblique coronal) could be utilized to prevent at‐risk structures from being damaged. The drilling angles and the safe zone can be employed to optimize the femoral tunnel in PCLR.

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Section: Exploring the Correlation Between Tunnel Orientation And The...mentioning

confidence: 99%

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Guo

Zhang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel

Guo,

Liu

2023

Front. Surg.

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Anterior cruciate ligament (ACL) tear is a common clinical injury, and ACL reconstruction has reached a very mature stage. However, with the accumulation of cases, scholars have found that isolated ACL reconstruction may not completely solve the problem of knee rotational stability. With the increase in our understanding of knee joint structure, ACL combined with anterolateral ligament (ALL) reconstruction has become accepted by most scholars, and this operation has also achieved good clinical results. At present, there is no unified surgical method for ACL combined with ALL reconstruction. There are differences in bone tunnel location, reconstruction methods, and graft selection. Compared with the independent reconstruction of the ACL and ALL during the operation, shared tendon graft reconstruction of the ACL and ALL has the advantages of preserving tendon and avoiding tunnel convergence. So far, there is no relevant literature summarizing the reconstruction of the ACL and ALL with a shared tendon graft. This paper reviews the anatomic study of the ALL, the study of isometric points, surgical indications, and surgical methods and their classification for shared tendon graft reconstruction of the ACL and ALL.

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An Analysis of the Femoral Drilling Angle to Avoid Tunnel Collision during Double-Bundle Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction on the Knee

Cited by 2 publications

References 38 publications

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel

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