Anatomical rectangular tunnels identified with the arthroscopic landmarks result in excellent outcomes in ACL reconstruction with a BTB graft

Abstract

Purpose To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) graft. Methods Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively. Results Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as 'normal' or 'nearly normal'. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT-1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from − 1 to + 2 mm. Conclusion By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients. Level of evidence Case series, Level IV.

Arthroscopic Anterior Cruciate Ligament Injury in Clinical Treatment of Joint Complications and CT Observation

“…The development of knee osteoarthritis after ACL injury will seriously affect the quality of life of patients [ 18 – 20 ]. Although the exact mechanism by which patellofemoral osteoarthritis occurs after ACL injury is unknown, patellofemoral arthropathy is seen on MRI in approximately half of young adults in the first year after ACL reconstruction [ 21 ].…”

Technical note: rectangular femoral tunnel for anterior cruciate ligament reconstruction using a new ultrasonic device: a feasibility study

“…This allows to place the tunnel aperture into the ACL footprint and reproduce the anatomy of the native ACL and its fiber insertions. Clinical results have shown to be excellent [ 28 ], but the technical feasibility of the rectangular bone tunnel may be challenging. To date, the use of US devices to create a femoral tunnel during an arthroscopic procedure has never been evaluated.…”

Gender Differences of the ACL Insertion Sites

“…Предрасположенность к повреждениям ПКС у женщин объясняется совокупностью отдельных факторов, среди которых анатомические особенности строения коленного сустава имеют ключевое значение. Сравнительно меньшая устойчивость Соблюдение анатомических принципов при выполнении реконструкции ПКС, таких как воссоздание индивидуальной формы, размеров, пространственного расположения трансплантата, приближенных к таковым у естественной связки конкретного пациента, становится определяющим в достижении положительных результатов лечения [39,40,41,42]. Напротив, среди ведущих причин неудачных исходов первичных и ревизионных реконструкций ПКС, независимо от половой принадлежности пациента, признается некорректное с анатомической точки зрения расположение тоннелей для проведения и фиксации трансплантата.…”

“…Согласно отдельным исследованиям, частота их составляет 22-79% случаев среди других причин, приводящих к отрицательным результатам лечения. Причем ошибочное расположение бедренного тоннеля встречается более чем у 35% пациентов, тогда как неправильный выбор топографии бед ренного и большеберцового тоннелей становится основной причиной подобных исходов более чем у 70% пациентов [41,42,43].…”