Anatomic Placement of the Femoral Tunnels in Double-Bundle Anterior Cruciate Ligament Reconstruction Correlates With Improved Graft Maturation and Clinical Outcomes

Ahn, Ji Hyun; Kim, Jong Dae; Kang, Ho Won

doi:10.1016/j.arthro.2015.04.098

Cited by 25 publications

(35 citation statements)

References 31 publications

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“…Therefore, after anatomic reconstruction, much portion of the remnant could be sacrificed. 9 The posterior (PM, PL, and trans-septal) portal is frequently used in our practices. 10 This technique allows for an easy viewing of posterior structures.…”

Section: Discussionmentioning

confidence: 99%

Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Elazab

Lee

Kang

2016

Arthroscopy Techniques

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We established a technique for femoral tunnel preparation through direct vision of the femoral footprint with maximum preservation to the native anterior cruciate ligament (ACL) remnant using a posterior trans-septal portal. Anterior arthroscopy is difficult for the proper tunnel placement without sacrificing the ACL remnant. Posterior arthroscopy could be helpful for viewing the posterior insertion of the ACL remnant that provides excellent femoral footprint exposure without sacrificing the native ACL remnant. Therefore, a posterolateral portal technique using a 70° arthroscope through a posterolateral portal is introduced. However, using the 70° arthroscope, an oblique view is displayed and distorted view could be seen. Therefore, to achieve the goal of posterior arthroscopy and avoid obstacles of the posterolateral view with the 70° arthroscope, we introduce this technique that uses the posterior trans-septal portal with a 30° arthroscope that provides an excellent viewing to the femoral footprint through a hole of the posterior septum.

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Section: Discussionmentioning

confidence: 99%

Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Elazab

Lee

Kang

2016

Arthroscopy Techniques

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“…The most common classification of graft integrity involved three categories according to the severity of graft tear: intact, partial (or superficial) tear, and complete (or substantial) tear [13,25,31]. Moreover, five studies categorized the percentage of the intact portion of the entire graft volume [9,10,18,28,29]. Ohsawa et al [28,29] described the integrity of the graft as "no tear" when more than 80% of the graft was intact, "partial tear" when 30-80% of the graft was intact, and "complete tear" when less than 30% of the graft was intact.…”

Section: Graft Integrity On Second-look Arthroscopymentioning

confidence: 99%

“…Many studies have evaluated graft maturation using second-look arthroscopy [5][6][7][8][9]. This method has several disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Evaluation parameters of graft maturation on second-look arthroscopy following anterior cruciate ligament reconstruction: a systematic review

Kim

Jung

Song

et al. 2019

Knee Surg & Relat Res

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Purpose: The purpose of this systematic review was to investigate and summarize the evaluation methods of graft maturation on second-look arthroscopy following anterior cruciate ligament (ACL) reconstruction. Methods: A literature search was performed on articles before December 2017 to identify the literature that has evaluated graft maturation on second-look arthroscopy following ACL reconstruction. Only studies using human grafts, evaluating graft maturation with two or more gross findings were included. Study design, grafts, surgical techniques, follow-up period, evaluation parameters, and categories were compiled. Results: Twenty-eight studies were included in this study. All studies evaluated graft maturation with two or more of the following three findings: graft integrity, tension, and synovial coverage. Two to four categories were used for evaluating each parameter, but the criteria for classification were slightly different for each study. Several studies reported neo-vascularization of grafts and the total maturation score by summing up the scores assigned to each evaluation parameter. Three studies reported that there was no correlation between second-look findings and patient-reported outcomes. Conclusions: Graft integrity, tension, and synovial coverage were the most frequently evaluated for graft maturation on second-look arthroscopy. However, there is no uniform criterion for evaluation. Therefore, development of a valid, uinform criterion is required. Level of evidence: Level IV, systematic review of level I-IV investigations.

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“…Femoral tunnel positioning is widely accepted to play an important role in preventing graft failure in ACL reconstruction . This is especially true for the DB reconstruction technique where non‐anatomic placement can lead to poorer clinical outcomes . However, variations in tunnel positioning even within the femoral footprint of the ACL insertion are possible, and how these variations might affect graft forces and failure rates is not clearly understood.…”

Section: Introductionmentioning

confidence: 99%

The biomechanical effect of tunnel placement on ACL graft forces in double‐bundle ACL reconstruction – A 3D computational simulation

Varady

Kernkamp

et al. 2017

Robotics Computer Surgery

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Anatomic Placement of the Femoral Tunnels in Double-Bundle Anterior Cruciate Ligament Reconstruction Correlates With Improved Graft Maturation and Clinical Outcomes

Cited by 25 publications

References 31 publications

Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Femoral Footprint Reconstruction With a Direct Viewing of the Posterior Insertion Using a Trans-Septal Portal in the Outside-In Anterior Cruciate Ligament Reconstruction

Evaluation parameters of graft maturation on second-look arthroscopy following anterior cruciate ligament reconstruction: a systematic review

The biomechanical effect of tunnel placement on ACL graft forces in double‐bundle ACL reconstruction – A 3D computational simulation

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