Anterior cruciate ligament reconstruction: Endoscopic versus two-incision technique

Harner, Christopher D.; Marks, Paul; Fu, Freddie H.; Irrgang, James J.; Silby, Mark B.; Mengato, Richard

doi:10.1016/s0749-8063(05)80004-0

Cited by 203 publications

(152 citation statements)

References 15 publications

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“…Thereby, the method of locating attachment site during operation is important. Fluoroscopically-assisted locating methods have been reported to increase the accuracy of graft placement [1,3,8,10,21,23], and they are especially helpful to locate the femoral tunnel [17]. Of the most frequently used methods, Amis' method has been proven to be more accurate and repeatable than Harners and Aglieffi's [21].…”

Section: Discussionmentioning

confidence: 99%

“…Femoral tunnel placement is believed to be an important factor in early failure ACL reconstruction [5,11]. Harner [10], Aglietti [1], and Edwards [3] developed methods to locate the femoral tunnel centre using roentgenograms. All these methods used Blumensaat's line as the only landmark to describe attachment location, which decreased the accuracy of graft placement [23].…”

Section: Introductionmentioning

confidence: 99%

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Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Guo

Yang

Wang

et al. 2008

International Orthopaedics (SICO

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The purpose of this study was to determine the relationships of the anterior cruciate ligament (ACL) femoral insertion site with femoral bony landmarks and develop a new method of location. Sixteen unpaired normal Chinese human cadaveric knees were used. Femoral insertion sites of the ACL were marked with metal wires. Four pairs of bony landmarks were selected: anatomical axis of distal femur (A) and parallel tangent of posterior condyles (B); tangent of anterior condyles parallel to landmark A (C) and landmark B; Blumensaat's line (D) and parallel tangent of distal condyles (E); and tangent of posterior condyles (F) and parallel tangent of anterior condyles (G). The X-Caliper was used to measure the distance between the centre of the insertion site and each pair of bony landmarks. The ratio of distances to each pair of bony landmark was calculated. Clock position of the ACL femoral footprint was measured on anteroposterior (AP) roentgenograms at 90 degree flexion. The centre of the ACL footprint was found at 65.3% ± 1.1% between A and B, 78.1% ± 1.0% between B and C, 38.3% ± 2.7% between D and E, and 43.1% ± 4.6% between F and G. The distances to bony landmarks A, B, D, and E have smaller variations. Blumensaat's line and the anatomical axis of the distal femur were regarded as more useful and made location of the insertion site more precise. A parallelogram made up of these two bony landmarks can be used. On AP roentgenograms, the centre of the femoral footprint should be moved to lower than the 10:00 o'clock (2:00) position.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Guo

Yang

Wang

et al. 2008

International Orthopaedics (SICO

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“…Nepaisant didelio skaièiaus klinikiniø tyrimø, kuriø metu buvo tiriamos priekinio kryþminio raiðèio traumos ir rekonstrukcijos, vis dar neaiðkios prieþastys, lemianèios sugráþimà á buvusá aktyvumo lygá. Beje, kitø tyrimø autoriai nenurodo tikslaus pacientø sugráþimo á buvusá fizinio aktyvumo lygá laiko, bet tik pageidautinà sugráþimo laikà (1,4,7,9,10,(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Visi tyrimai, deja, buvo sukoncentruoti tik á sugráþimo faktà, bet ne sugráþimo laikà (1,4,7,9,10,(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Lentelë Galutinis Ikdc áVertinimasunclassified

A prospective comparison of double- and single-bundle anterior cruciate ligament reconstructions

Gudas¹,

Smailys²,

Vostrugina³

et al. 2008

Medicina

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ÁvadasDël maþesnës donorinës vietos sindromo tikimybës vis daþniau priekinio kryþminio raiðèio (PKR) rekonstrukcijos operacijos sportininkams atliekamos panaudojant ðlaunies lenkiamøjø sausgysliø transplantatus, kurie fiksuojami tirpiaisiais sraigtais viename arba dviejuose kaulo kanaluose (1-4). Kryþminio raiðèio transplantà fiksuojant viename kanale, atliekama vieno pluoðto, o fiksuojant dviejuose kanaluose -dviejø pluoðtø rekonstrukcija. Dviejø pluoðtø PKR (DP-PKR) rekonstrukcija anatomiðkai tiksliau atkuria plyðusá kryþminá raiðtá, taèiau dël metodikos sudëtin-gumo klinikinëje praktikoje taikoma labai retai. Atliekant vieno pluoðto priekinio kryþminio raiðèio (VP-PKR) rekonstrukcijà, labai svarbu transplantà ásodinti á anatomiðkai bei funkciðkai labai tikslià kelio sànario vietà. To nepadarius, PKR rekonstrukcija neatkurs stabilaus kelio sànario anatomijos, nors pacientui po tokios operacijos bus ðiek tiek geriau, bet aktyvios fizinës ir kontaktinës veiklos sportininkas taesti negalës. Todël pasaulinëje praktikoje vis daþniau atliekama DP-PKR rekonstrukcija, kuri teoriðkai turëtø bûti pranaðesnë uþ standartinae vieno pluoðto PKR rekonstrukcijà. Taèiau nëra klinikiniø tyrimø, árodanèiø vieno ar kito PKR rekonstrukcijos metodo pranaðumà.Ðio tyrimo tikslas -palyginti klinikinius ir radiologinius rezultatus sportininkams po PKR dviejø pluoðtø ir vieno pluoðto rekonstrukcijos. Pirminiai ðio tyrimo tikslai -iðtirti iki traumos fizinio aktyvumo lygio atkûrimà bei DP-PKR rekonstrukcijos galimà pranaðu-mà prieð áprastà vieno pluoðto PKR rekonstrukcijà. Tirtøjø kontingentas ir tyrimo metodai

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“…Impingement on the graft appears to be caused by the incorrect placement of the tibial tunnel and a small slope of the intercondylar roof. 4,5,15,18,27,31,32 In recent years, significant interest has been shown in the development of computer-assisted surgery as having potential for improving accurate tunnel placement. 11,20 During arthroscopic surgery, guides, fluoroscopically assisted techniques, and active and passive systems with the additional use of CT scan have been introduced.…”

mentioning

confidence: 99%

Differences in the Placement of the Tibial Tunnel during Reconstruction of the Anterior Cruciate Ligament with and without Computer-Assisted Navigation

Mauch

Apic²,

Becker³

et al. 2007

Am J Sports Med

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Background Next to graft fixation, correct positioning of the tibial and femoral tunnel is a deciding factor for the clinical result of anterior cruciate ligament reconstruction surgery. Computer-assisted navigation has been proposed as a method to improve tunnel positioning. Purpose To examine the differences in tibial tunnel placement between cruciate ligament operations using manual and computer-assisted navigation. Study Design Randomized controlled trial; Level of evidence, 1. Methods Between December 2003 and April 2004, 53 athletes underwent anterior cruciate ligament reconstruction surgery with arthroscopic press-fit technique. The first group (group N; 24 athletes) were operated on with the aid of a navigation system (OrthoPilot, Aesculap AG & Co. KG, Braun), and the second group (group M; 29 athletes) were “manually” operated on. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel four days postoperatively. In the measurements, the anterior and posterior boundaries of the tibial tunnel, as well as the center of the tibial tunnel in relation to the maximum tibia anteroposterior diameter were evaluated (indicated in percent). An analysis of the tibial tunnel position proportional to the slope of the intercondylar roof was done to determine intercondylar impingement (method according to Howell). The centers of the tibial tunnels were compared with the “optimal” position noted in previous studies. The standard deviation was determined for both groups to determine the variance of placement. Results The anterior tibial tunnel border was 19.4 mm in group M (29.7%) and 21.2 mm in group N (32.2%) (P=.18). The center of the tibial tunnel was located at 24.6 mm in group M (35.6%) and at 26.6 mm in group N (40.3%) (P=.19). In group M, the posterior tibial tunnel position was located at 30.2 mm (46.2%), and in group N at 32.2 mm (49.1%) (P=.21). When comparing the centers of the tibial tunnels with the optimal 44% found in previous studies, the value for group M (37.6%) varied significantly, while group N (40.5%) did not. However, there was no significant difference in the range variance for either group; the standard deviation was 6.9% (4.3 mm) for group M and 5.9% (3.5 mm) for group N. One athlete showed moderate impingement in group N, and two athletes in group M. Conclusion Assisted navigation offers good support for correct placement of the tibial tunnel, although experienced surgeons can achieve essentially the same positioning as surgeons using computer-assisted navigation. Whether it is advisable to implement this procedure in daily surgical routine should be decided based on clinical results.

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Anterior cruciate ligament reconstruction: Endoscopic versus two-incision technique

Cited by 203 publications

References 15 publications

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

A prospective comparison of double- and single-bundle anterior cruciate ligament reconstructions

Differences in the Placement of the Tibial Tunnel during Reconstruction of the Anterior Cruciate Ligament with and without Computer-Assisted Navigation

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