Comparisons of Femoral Tunnel Position and Length in Anterior Cruciate Ligament Reconstruction: Modified Transtibial Versus Anteromedial Portal Techniques

Chang, Chong Bum; Choi, Ja Young; Koh, In Jun; Lee, Kil Jae; Lee, Kyung Hag; Kim, Tae Kyun

doi:10.1016/j.arthro.2011.06.013

Cited by 70 publications

(65 citation statements)

References 27 publications

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“…Its potential disadvantages, on the other hand, include the creating of short sockets, posterior wall blowout, distal/inferior exit in the lateral thigh endangering the peroneal nerve, possible impingement of the aimer at the inter-condylar notch throughout the entire range of motion, possible damage to the medial femoral condyle cartilage and other technical difficulties [19]. In fact, a retrospective study that compared femoral tunnel position and length found that tunnels drilled by using AMP were significantly shorter and more oblique, and that a larger rate of the tunnels were shorter than 30 mm, compared to the transtibial technique [7]. Nevertheless, the AMP approach has gained popularity since it was first introduced a few years ago, and its use has expanded [19].…”

Section: Surgical Approach For Drilling the Femoral Tunnelmentioning

confidence: 99%

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An international survey on anterior cruciate ligament reconstruction practices

Chechik

Amar

Khashan

et al. 2012

International Orthopaedics (SICOT)

163

134

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Purpose Bone-patellar-tendon-bone (BPTB) autografting fixed with metal interference screws (IS) is the gold standard for anterior cruciate ligament (ACL) reconstruction. Advances in surgical technology provide a wide choice of grafts, fixation devices and surgical approaches. Methods Two-hundred and sixty-one orthopedic surgeons of ten subspecialties from 57 countries were surveyed on their choice of graft and fixation device, the number of reconstructed bundles, and arthroscopic portal. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications. Results Hamstring autografting was the most popular choice (63 %), then BPTB (26 %) and allograft (11 %). The anteromedial portal was preferred over the traditional transtibial portal (68 % versus 31 %). Two-thirds reported routinely performing a single-bundle graft reconstruction, compared to one-third who used the double-bundle technique. The Endo-button was the most common graft fixation method (40 %), followed by the bioabsorbable IS (34 %), metallic IS (12 %), rigidfix (10 %) and others (4 %). The preferences of hamstring tendon grafting and the anteromedial portal are not supported in the literature. Responses from North American and European surgeons were different from all the others.Conclusions Surgeon preferences in ACL reconstruction differ considerably worldwide. Common practice is not always supported by evidence-based publications.

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Section: Surgical Approach For Drilling the Femoral Tunnelmentioning

confidence: 99%

“…Approximately 300,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA alone each year [7]. Historically, ACL reconstructions were performed using bone-patellar-tendon-bone (BPTB) autografts fixed with metal interference screws (IS).…”

Section: Introductionmentioning

confidence: 99%

An international survey on anterior cruciate ligament reconstruction practices

Chechik

Amar

Khashan

et al. 2012

International Orthopaedics (SICOT)

163

134

View full text Add to dashboard Cite

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“…More recently, femoral tunnel drilling through an anteromedial arthroscopic portal has become much utilized, allowing the surgeon to return to independent tunnel drilling in order to improve the ability to replicate the ACL's femoral footprint without compromising the tibial footprint's position. The anteromedial portal technique for drilling femoral tunnels is reported to achieve a more oblique femoral tunnel position, and typically results in shorter tunnel length than tunnels created with the transtibial technique (4)(5)(6).…”

Section: Original Researchmentioning

confidence: 99%

“…Femoral tunnels are shorter, and more oblique when created using antero-medial portal technique compared to transtibial tunnel technique (4,5,14). Knowledge of these differences can be helpful when attempting to determine which technique was used by radiographs or coronal CT or MRI.…”

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confidence: 99%

Identification of Anterior Cruciate Ligament Tunnel Drilling Technique Using X-Ray

Dumont¹,

Russell²,

Wilson³

et al. 2015

TOJ

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Introduction: Anterior cruciate ligament (ACL) reconstruction is commonly performed and surgeons use different techniques to drill the femoral tunnel. Failed ACL reconstruction is most frequently due to tunnel malposition. The ability to identify which tunnel drilling technique was used is important in revision situations. The purpose of our study was to evaluate the utility of radiographs in differentiating between femoral tunnels drilled through the anteromedial portal or the transtibial tunnel. Methods: Radiographs from 40 patients (20 transtibial tunnel technique and 20 anteromedial portal technique) were presented to 8 different reviewers (4 orthopaedic faculty and 4 trainees), at two separate occasions. We evaluated the overall number of times the correct technique was identified, as well as compared the accuracy of the observers' first and second attempts. The accuracy of faculty surgeons was compared to that of trainees. Results: The correct technique was identified 591/640 (92.3%) times. There was no difference between the accuracy of faculty members and trainees in identifying the correct technique (93.4% vs 91.2%, respectively. There was no difference in accuracy between the first and second trials (92.5% and 92.2%, respectively). Intraobserver agreement was high, at 92.8% for all trials. 34 of 40 (85%) of radiographs were identified correctly on at least 6 of 8 attempts. Discussion: Radiographs are a useful tool in distinguishing between femoral tunnels drilled using the transtibial tunnel and anteromedial portal in ACL reconstruction. Faculty and trainees alike are highly accurate in identifying the technique utilized. When the radiographs are unclear, repeat radiographs or additional axial imaging may be necessary in planning revision ACL reconstruction. Keywords: ACL reconstruction; Anteromedial portal; Transtibial tunnel. Identification of Anterior Cruciate Ligament Tunnel

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“…We believe the single-bundle reconstruction shown here is technically easier than any current double-bundle technique. Longer tunnel lengths 12 No risk of damaging articular cartilage on medial femoral condyle 13 Harder to achieve anatomic femoral tunnel 14 Decreased joint kinematics at time 0 compared with anteromedial drilling 15 Suspensory femoral fixation Graft can be placed more posteriorly; no need to worry about posterior femoral blowout Minimal potential for intra-articular femoral hardware Easier to perform revision surgery Does not achieve compressive fixation of tendon to bone Possible tunnel widening due to windshield-wiper effect Single-bundle reconstruction Easier surgical technique Outcomes similar to double-bundle reconstruction 16 Decreased time 0 kinematics compared with double bundle Native anatomy is not completely restored…”

Section: E90mentioning

confidence: 99%

Technique for Arthroscopic-Assisted Primary Anterior Cruciate Ligament Reconstruction Using Doubled Tibialis Anterior Tendon

Rose

Crawford

2017

Arthroscopy Techniques

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Advances in surgical technique and our knowledge of anterior cruciate ligament (ACL) anatomy have resulted in a marked increase in options for ACL reconstruction. Currently, patient age and activity level, surgeon preference and experience, and cost are factors influencing the type of reconstruction recommended to address knee instability. We present a simplified transtibial method of ACL reconstruction using a single-bundle, doubled tibialis anterior allograft. This method uses fixation with a suspensory device on the femur and a bio-composite interference screw on the tibia. We recommend this simplified technique for primary ACL reconstruction because it minimizes total steps, thus limiting variance, maximizing efficiency, and reducing potential technical error.A nterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopaedic surgeons with the goal of restoring functional stability.1 Advances in surgical technique have resulted in a marked improvement in outcomes, and current options for surgical reconstruction are numerous.2,3 The choice of reconstruction technique is dependent on surgeon experience and numerous patient factors, in balance with considerations of cost, efficacy, and long-term outcomes. We propose a single-bundle transtibial method using a doubled tibialis anterior allograft fixed with a suspensory device on the femoral cortex and a bio-composite interference screw in the tibia. We believe this technique simplifies ACL reconstruction by limiting the number of steps with an aim at reducing potential errors while providing an anatomic reconstruction. Surgical TechniqueACL reconstruction (Video 1) is performed by combining general anesthesia and a continuous-infusion femoral nerve catheter (0.2% ropivacaine) left in place for 72 hours to maximize pain control and minimize need for systemic narcotics. The patient is placed supine on a standard operating table, and full examination of the knee is performed including grading of the Lachman, anterior drawer, and pivot-shift tests. A lateral post is placed high on the thigh, and the leg is prepared and draped in sterile fashion. The leg is allowed to hang laterally over the side of the table and flexed to a minimum of 90. A lateral parapatellar portal is then made with a No. 11 blade even with the distal pole of the patella, creating an incision larger at the skin than the joint (one-way valve). A complete diagnostic evaluation is performed using lactated Ringer solution with epinephrine (1 mL of 1:1,000 per 5 L) and gravity flow. Concomitant meniscal or chondral pathology is noted and addressed. A medial working portal is then created with a No. 11 blade after localization with a spinal needle. The portal is placed just proximal and medial to the anterior horn of the medial meniscus. A 4.5-mm vacuum shaver is introduced through a medial working portal, and the torn fibers of the ACL are debrided minimally, focusing on those subluxated anteriorly and the midsubstance elements that are displaced. Ca...

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Comparisons of Femoral Tunnel Position and Length in Anterior Cruciate Ligament Reconstruction: Modified Transtibial Versus Anteromedial Portal Techniques

Cited by 70 publications

References 27 publications

An international survey on anterior cruciate ligament reconstruction practices

An international survey on anterior cruciate ligament reconstruction practices

Identification of Anterior Cruciate Ligament Tunnel Drilling Technique Using X-Ray

Technique for Arthroscopic-Assisted Primary Anterior Cruciate Ligament Reconstruction Using Doubled Tibialis Anterior Tendon

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