Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction

Sudhahar, T.; Glasgow, M. M. S.; Donell, Simon T.

doi:10.1016/s0968-0160(03)00100-5

Cited by 33 publications

(15 citation statements)

References 9 publications

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“…31 This is an important consideration, given that in the transtibial technique, the femoral tunnel is dependent on the location of the tibial tunnel. Issues such as these have led to increased popularity of the anteromedial portal, which was used in 35% of the MARS cohort.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

Wright¹

2013

J Knee Surg

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The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature.

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Section: Discussionmentioning

confidence: 99%

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

Wright¹

2013

J Knee Surg

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“…In dogs, tunnel placement for intraarticular CCL reconstruction has traditionally been performed without the use of an aiming device from intra‐ to extraarticular through a standard parapatellar approach 2,7,43–49 . Stifle arthroscopy results in less morbidity and a superior observation of intraarticular structures 50,51 ; however, when attempting arthroscopic intraarticular CCL reconstruction in dogs, 3 factors might be of concern: (1) tibial tunnel placement has to be extra‐ to intraarticular and because free hand drilling has been shown as unreliable in people, 38,39 the use of an universal aiming device appears appropriate 29 ; (2) the precise exit point on the CenterTib may be obscured by the intermeniscal ligament, 52 which, similar to people, suggests the placement of the tibial tunnel in relation to other intraarticular landmarks rather than the tibial insertion itself; and (3) considering the heterogenic shape and size of the canine skeleton, individualized tunnel placement according to a dog's specific anatomic conformation seems logical.…”

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confidence: 99%

“…The angles that the tibial and femoral bone tunnels are drilled also affect the functional outcome in people. [34][35][36][37] Even for experienced human orthopedic surgeons, free hand drilling of the tibial tunnel from extra-to intraarticular leads to a significant misplacement in most cases, 38,39 and the use of specially designed aiming devices is strongly advised. 40 Because the CenterTib might be challenging to identify during arthroscopy, aiming devices for human application are geared to anatomic landmarks easily identified on arthroscopy, such as the posterior cruciate ligament (PCL).…”

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confidence: 99%

Development and In Situ Application of an Adjustable Aiming Device to Guide Extra‐ to Intraarticular Tibial Tunnel Drilling for the Insertion of the Cranial Cruciate Ligament in Dogs

et al. 2010

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“…Placement of the tibial tunnel, however, shows a much wider range in our research and in previous studies. 21,33 Previously, placement at the frontal anatomical insertion was preferred, 9 but several new studies have shown that placement in the rear third of the previous anatomical insertion is more suitable for avoiding impingement. [17][18][19] Operative anatomical landmarks for orientation are the medial tibial eminence, the PCL, and the posterior border of the lateral meniscus.…”

Section: Discussionmentioning

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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Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction

Cited by 33 publications

References 9 publications

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

Development and In Situ Application of an Adjustable Aiming Device to Guide Extra‐ to Intraarticular Tibial Tunnel Drilling for the Insertion of the Cranial Cruciate Ligament in Dogs

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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