Anterior Cruciate Ligament Femoral Tunnel Drilling Through Anteromedial Portal: Axial Plane Drill Angle Affects Tunnel Length

Hamilton, Stephen C.; Jackson, Edward R.; Karas, Spero G.

doi:10.1016/j.arthro.2010.10.002

Cited by 14 publications

(16 citation statements)

References 22 publications

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“…Iyyampillai et al suggested that femoral tunnel drilling with maximal knee hyperflexion in ACL reconstruction consistently produced tunnel lengths greater than 30 mm with no posterior wall fractures [26]. However, others have suggested that increased sagittal inclination or reduced guide wire axial angles have little effect on tunnel length [20, 25, 27]. Some have refuted the correlation of knee flexion angle with tunnel length because maximum flexion varies from one subject to another.…”

Section: Discussionmentioning

confidence: 99%

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique

Wang

Lee

Chung

et al. 2017

BMC Musculoskelet Disord

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Background: Commercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42 o curved guide.

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Section: Discussionmentioning

confidence: 99%

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique

Wang

Lee

Chung

et al. 2017

BMC Musculoskelet Disord

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“…Earlier studies on the length of femoral tunnel in AM portal drilling4,10,11) were cadaveric studies and consequently the number of parameters that can be analysed in a single study was limited and small variations were not reported. These studies have also been limited by lack of standardisation of the entry point of femoral tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…Hamilton et al reported that the length of femoral tunnel reduces with increased axial angle of drilling10). Their study was done with the knee in 120° flexion.…”

Section: Discussionmentioning

confidence: 99%

“…In this position, the hip flexion varies with knee flexion and studies in the available literature do not account for this fact. The available studies on this subject have analysed the tunnel length with respect to knee flexion during femoral tunnel drilling or axial angle of guidewire4,10,11). However, there is no study objectively analysing the three dimensional relationship between tunnel orientation and length.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Femoral Tunnel Length in Anterior Cruciate Ligament Reconstruction: CT Analysis of the Influence of Tunnel Orientation on the Length

Iyyampillai

Raman

Rajan

et al. 2013

Knee Surg Relat Res

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PurposeThe purpose of the study was to identify the femoral tunnel orientation that consistently results in a tunnel length of more than 35 mm in anterior cruciate ligament reconstruction.Materials and MethodsComputed tomography (CT) scans were obtained from 30 patients who did not have any pathology in the distal femur. Virtual tunnels were marked on 3D (3-dimensional) reconstructed CT images after determining the orientation defined by sagittal inclination and axial angle. The length of a femoral tunnel in 64 different combinations of orientations (between 30° and 65° in 5° increments in two planes) was measured on 3D reconstructed images in both knees in 30 patients. Reliability of measurement was assessed with correlation coefficient for intra-observer and inter-observer measurements. A one-way analysis of variance (ANOVA) was used for statistical analysis.ResultsThe mean femoral tunnel length varied significantly with each 10° change in orientation in both planes (p<0.05, ANOVA). A femoral tunnel of more than 35 mm in length could be obtained only with a sagittal inclination of more than 50° and axial angle of 30°-45°. When the axial angle was kept constant, the tunnel length increased with the increase in sagittal inclination. Higher sagittal inclinations consistently resulted in longer tunnels (r>0.9) and reduced the incidence of posterior cortical breakage.ConclusionsA tunnel orientation with an axial angle between 30°-45° and a sagittal inclination of more than 50° can result in a tunnel length of more than 35 mm.

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“…[10][11][12][13] Synthetic test media correctly manufactured with appropriate mechanical properties replicating the biologic environment could prove to be an acceptable testing environment because of the lack of variability, decreased cost, absence of risk for disease transmission, and ready availability. 10,[13][14][15][16] Orthopaedic investigators have used constructs of rigid polyurethane foam as a cheaper, safer, and more available alternative to human cadaver or other biologic models for the spine, [16][17][18][19] lower extremity fracture, 12,20-23 the foot and ankle, 24-28 knee fixation 29 including anterior cruciate ligament (ACL) studies, 30 the hip, 10 the shoulder, 31 and the hand. 11,32 Our purpose was to compare the load-to-failure pullout strength of bonee patellar tendonebone (BPTB) allografts in human cadaver tibias and rigid polyurethane foam blocks.…”

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confidence: 99%

Pullout Strength of Bone–Patellar Tendon–Bone Allograft Bone Plugs: A Comparison of Cadaver Tibia and Rigid Polyurethane Foam

Barber

2013

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Anterior Cruciate Ligament Femoral Tunnel Drilling Through Anteromedial Portal: Axial Plane Drill Angle Affects Tunnel Length

Cited by 14 publications

References 22 publications

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique

Determinants of Femoral Tunnel Length in Anterior Cruciate Ligament Reconstruction: CT Analysis of the Influence of Tunnel Orientation on the Length

Pullout Strength of Bone–Patellar Tendon–Bone Allograft Bone Plugs: A Comparison of Cadaver Tibia and Rigid Polyurethane Foam

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