Abstract:PurposeIn anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel.Surgical TechniqueWe present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique.Materials and MethodsBetween January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 1… Show more
“…The footprint sites of the ACL were determined by referring Tsukada's method on the tibial side and the quadrant's method of Bernard in the sagittal plane, referring to anthropometry data in previous studies . In addition, tunnels of the tibia and the femur were made on the cross‐section of the tibia, according to the outside‐in surgical method, using the results of anatomical coordinate axes measurement …”
Considering the availability of surgery, it was identified that the optimum femoral tunnel location is at 10 mm radius locations at a proximal posterior of 45°.
“…The footprint sites of the ACL were determined by referring Tsukada's method on the tibial side and the quadrant's method of Bernard in the sagittal plane, referring to anthropometry data in previous studies . In addition, tunnels of the tibia and the femur were made on the cross‐section of the tibia, according to the outside‐in surgical method, using the results of anatomical coordinate axes measurement …”
Considering the availability of surgery, it was identified that the optimum femoral tunnel location is at 10 mm radius locations at a proximal posterior of 45°.
“…However, when the projecting point of the tibial tunnel and the marked point of the femoral tunnel is within 5 mm, locating the femoral tunnel at the right point through the 8- to 10-mm wide tibial tunnel is not a problem, because the direction of the tubular femoral tunnel–aiming device can be adjusted to a wide range ( Fig 18 ). 7 Fig 18 Change of direction of the femoral tunnel–aiming device within the tibial tunnel. …”
Section: Discussionmentioning
confidence: 99%
“…However, when the projecting point of the tibial tunnel and the marked point of the femoral tunnel is within 5 mm, locating the femoral tunnel at the right point through the 8-to 10-mm wide tibial tunnel is not a problem, because the direction of the tubular femoral tunneleaiming device can be adjusted to a wide range (Fig 18). 7 This special technique of tibial tunnel creation results in a shallow tibial tunnel with a length of 35 to 40 mm and an outer orifice 15 to 20 mm below the medial tibial plateau. Because the length of graft that would be placed in the tibial tunnel is 25 to 30 mm, the tibial tunnel can accommodate the graft without tendon extrusion.…”
Anatomical anterior cruciate ligament (ACL) reconstruction is a reasonable transition from isometric ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through the medial portal technique. However, in our clinical practice, we found that anatomical ACL reconstruction can be performed easily and accurately by creating a tibial tunnel, which is accomplished by setting the tibial tunnel with correct angulation to the sagittal plane and tibial axis. Hence, we introduce this special transtibial anatomical ACL reconstruction technique, in which the most critical step is the creation of a shallow tibial tunnel with a proximal projection to the anatomical location of the femoral tunnel. This technique is indicated for primary ACL reconstructions in skeletally mature patients. We believe this Technical Note will give a special view on anatomical ACL reconstruction.
“…Although, there is no need to worry about the iatrogenic problems that are potential complica-tions in the transportal technique, it is relatively demanding to reach the center of the native ACL footprint using this technique. 35,37,72,78,79,82,87 In the outside-in technique, no restrictions exist for femoral tunnel placement. However, special devices such as a backward drill are required, and a femoral incision is needed.…”
The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms “anterior cruciate ligament reconstruction,” “anatomic or anatomical,” and “single bundle.” Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow–deep direction (32.3%) and in a high–low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.
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