Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction

Heming, James F.; Rand, Jason D.; Steiner, Mark E.

doi:10.1177/0363546507304137

Cited by 243 publications

(249 citation statements)

References 37 publications

Supporting

Mentioning

237

Contrasting

Unclassified

Order By: Relevance

“…Anatomic placement is considered optimal to provide maximum stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel [1,11,23,26]; however, the results of this approach have sometimes been disappointing because a more vertical graft could limit rotational stability [37,45]. Some have therefore suggested that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial drilling portal [8,13,20].…”

Section: Introductionmentioning

confidence: 99%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

show abstract

Section: Introductionmentioning

confidence: 99%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…The direct relationship between the drill-guide angle and surgical outcome has not been established. A small drillguide angle may damage tissues adjacent to the tunnel aperture [9], reduce the graft-tunnel bonding [7], attenuate the bone between the tunnel roof and tibial plateau, and cause micro-fracture trauma in the subchondral bone [8]. Conversely, a large drill-guide angle led to a long bone tunnel, which may mismatch the graft length and cause a great bone removal.…”

Section: Discussionmentioning

confidence: 99%

“…A small drill-guide angle reduced the graft-tunnel bonding [7], attenuated the bone between the tibial plateau and tunnel roof, and might cause micro-fracture in the tibial plateau [8].…”

mentioning

confidence: 99%

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction

Yao

Wen

Zhang

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The tibial drill-guide angle in anterior cruciate ligament (ACL) reconstruction influences the tunnel placement and grafttunnel force, and is potentially associated with post-operative tunnel widening. This study aimed to examine the effect of the drill-guide angle on the stress redistribution at the tibial tunnel aperture after anatomic single-bundle ACL reconstruction. Methods A validated finite element model of human knee joint was used. The tibial tunnel with drill-guide angle ranging from 30°to 75°was investigated. The post-operative stress redistribution in tibia under the compressive, valgus, rotational and complex loadings was analysed.Results Compressive loading played a leading role on the stress redistribution at intra-articular tibial tunnel aperture. After ACL reconstruction, stress concentration occurred in the anterior and posterior regions of tunnel aperture while stress reduction occurred in the lateral and posteromedial regions under the compressive loading. Stress redistribution was partially alleviated by using the drill-guide angle ranging from 55°to 65°. Conclusions The present study quantified the effect of bone tunnel drill-guide angle on the post-operative stress redistribution. This phenomenon potentially contributed to tunnel widening. A tunnel drill-guide angle ranging from 55°to 65°was proposed based on the biomechanical rationale. It could serve as a helpful surgical guide for ACL reconstruction.

show abstract

“…Controversy exists as to whether anatomical tunnel placement can be achieved using a transtibial tunnel drilling [80].…”

Section: Anatomical Single Bundle Techniquesmentioning

confidence: 99%

Anatomical single bundle anterior cruciate ligament reconstruction

Carmont

Scheffler

Spalding

et al. 2011

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

show abstract

Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction

Cited by 243 publications

References 37 publications

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction

Anatomical single bundle anterior cruciate ligament reconstruction

Contact Info

Product

Resources

About