Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee

Sutter, E. Grant; Anderson, John A.; Garrett, William E.

doi:10.1016/j.eats.2014.11.017

Cited by 9 publications

(6 citation statements)

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“…The presence of a remnant, particularly if large, can obscure a complete view of the anatomy of the notch. 12 , 31 , 38 Preservation of the ACL remnant during reconstruction is considered important, as it may confer improved knee stability. 2 , 4 , 25 , 26 , 27 , 35 It is postulated that a greater intrinsic potential for healing, 28 better graft vascularization, 26 , 28 and preservation of proprioceptive nerve fibers 21 can result in reduced rates of graft rupture 1 , 3 , 12 , 16 – 18 , 33 , 34 , 40 and improved proprioceptive function.…”

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confidence: 99%

Three-Dimensional CT Evaluation of Tunnel Positioning in ACL Reconstruction Using the Single Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

Buscayret

Temponi

Saithna

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Remnant preservation may confer important advantages in the anterior cruciate ligament (ACL)–reconstructed knee. However, the presence of a large remnant may obscure visualization and impair the ability to correctly place tunnels during surgery.Purpose:To determine whether tunnel placement during anatomic ACL reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique is consistent and precise when a large native remnant is preserved.Study Design:Case series; Level of evidence, 4.Methods:Included in this study were 99 patients undergoing an ACL reconstruction during which at least 50% of the native ACL was preserved. The femoral tunnel was created using an outside-in specific guide. The tibial tunnel was positioned in the anteromedial region of the ACL footprint, and the remnant was carefully preserved while drilling and passing the semitendinosus graft through it. Postoperatively, 3-dimensional computed tomography (3D CT) was used to evaluate tunnel placement. The mean tunnel locations were calculated and the standard deviation was used to evaluate precision of positioning. Inter- and intrareader agreement were determined to assess reliability of evaluation of tunnel position.Results:The center of the femoral tunnel was positioned at a mean 19.4% (SD, 2%) of the depth of the notch and a mean 23.1% (SD, 3.5%) of the lateral wall height. The center of the tibial tunnel was positioned at a mean 36.3% (SD, 3.8%) of the anteroposterior length of the tibial plateau and at a mean 47.0% (SD, 2.7%) of the mediolateral width. The small standard deviations demonstrate that this technique allows precise tunnel placement. The tunnel positions achieved were consistent with previous anatomic studies of femoral and tibial anteromedial bundle insertion. Intra- and interobserver reliability were high.Conclusion:Three-dimensional CT evaluation demonstrated that despite the presence of a large remnant, placement of femoral and tibial tunnels for anatomic ACL reconstruction using the SAMBBA technique is consistent and precise.

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confidence: 99%

Three-Dimensional CT Evaluation of Tunnel Positioning in ACL Reconstruction Using the Single Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

Buscayret

Temponi

Saithna

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…In addition, a non‐anatomic tunnel position (anterior and proximal femoral tunnels) is likely to increase the risk of revision ACL [4]. The presence of residues, especially large ones, may obscure the view of the anatomical entrance and exit points used for tunnel positioning [9, 25, 30]. Compared with the posterior trans‐septal portal technique, the transportal technique applied in this study is unable to evade the influence of ACL femoral residues.…”

Section: Discussionmentioning

confidence: 99%

ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning

Liu

Wang

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study aimed to comparatively evaluate the accuracy of femoral tunnel positioning after anatomic single‐bundle anterior cruciate ligament (ACL) reconstruction performed with the remnant preservation (RP) technique versus the non‐remnant preservation (NRP) technique. MethodsA retrospective review of 145 patients who underwent ACL reconstruction from May 2020 to May 2022 were performed in this single‐surgeon study. A total of 120 patients met the inclusion criteria and were allocated into two groups according to the surgical technique (i.e. RP group and NRP group). The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using a standardized grid system on the three‐dimensional computed tomography (3D‐CT) image. The accuracy and precision of the RP group were assessed based on published anatomical data in direct comparison with the NRP group. ResultsAccording to the surgical procedure, 57 of the 120 patients included were allocated into the RP group, and 63 into the NRP group. Significant differences were observed between the two groups in terms of tunnel position (posterior‐to‐distal (PD): 28.4 ± 5.4% (RP) vs. 31.8 ± 5.3% (NRP); P = 0.01), (anterior‐to‐posterior (AP): 32.6 ± 7.7% (RP) vs. 38.8 ± 7.7% (NRP); P = 0.00), while no significant differences were found in terms of the accuracy (8.6% (RP) vs. 8.9% (NRP); n.s) and precision (4.4% (RP) vs. 5.6% (NRP); n.s) of femoral tunnel positioning between the two groups. ConclusionsFrom this single‐surgeon study, it was concluded that there were no differences in the creation of ACL femoral tunnel between the RP technique and the non‐remnant preserving technique. Meanwhile, the RP technique would not sacrifice the ideal position of the femoral tunnel and is able to retain the possible benefits of the ACL stump. Level of evidenceLevel III.

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“…With this observation technique, ACL surgeons could identify the footprint to create the femoral tunnel anatomically without any debridement of the remnant 22 ( Figure 4 ). Sutter et al 23 reported that the arthroscopic technique with a minimum amount of remnant debridement enables ACL surgeons to perform more accurate femoral placement. They visualized the existing footprint directly from the anteromedial portal combined with outside-in drilling.…”

Section: Remnant-preserving Acl Reconstructionmentioning

confidence: 99%

Anterior cruciate ligament remnant and its values for preservation

Muneta

Koga

2017

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Controversy surrounds the remnant-preserving anterior cruciate ligament surgery. Advantages of remnant preservation have been reported in regard to better healing and knee function, although no consensus has been reached. This review article discussed the value and meaning of anterior cruciate ligament remnant preservation in several sections such as effects on healing, remnant classification, biomechanical evaluation, relation to proprioception, animal studies, and clinical studies. We hope that this review will facilitate further discussion and investigation for better treatment of anterior cruciate ligament injuries. So far, the current reviews have not provided sufficient scientific evidence to support the value of preserving the remnant.

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Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee

Cited by 9 publications

References 20 publications

Three-Dimensional CT Evaluation of Tunnel Positioning in ACL Reconstruction Using the Single Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

Three-Dimensional CT Evaluation of Tunnel Positioning in ACL Reconstruction Using the Single Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning

Anterior cruciate ligament remnant and its values for preservation

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