Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

Muller, Bart; Hofbauer, Marcus; Atte, Akere; Dijk, C. Niek van; Fu, Freddie H.

doi:10.1007/s00167-014-3181-4

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…Eight included studies 9 , 15 , 16 , 20 , 21 , 23 , 33 , 35 quantified femoral tunnel positioning by utilizing radiologic parameters. No studies reported any significant difference in the intra-articular femoral tunnel aperture location.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, many of the studies directly comparing the use of AM-FR and AM-RR have contained a low level of evidence and differed in the radiographic modality used for assessment. Specifically, several included studies 15 , 23 , 33 , 35 utilized radiographs for evaluation of tunnel positioning and measurement, which may be less accurate than other modalities of advanced imaging (see Table 1 ). Therefore, further study is required to more clearly define the anatomic or radiologic differences that result from the use of these 2 methods.…”

Section: Discussionmentioning

confidence: 99%

“…15,16,20,36 Table 3 illustrates a comparison of 6 studies that reported femoral tunnel positioning in the frontal, coronal, sagittal, or axial plane. 15,20,21,23,33,35 Two out of 3 studies 15,33,35 reported a significant difference in tunnel positioning in the sagittal plane, with AM-FR resulting in greater tunnel anteversion in these studies (Figure 3). 33,35 One out of 5 studies 15,20,21,23,33 reported a significant difference in tunnel positioning in the frontal or coronal plane, with AM-FR resulting in a less vertically oriented tunnel in this instance (Figure 3).…”

Section: Radiologic Outcomesmentioning

confidence: 96%

“…15,20,21,23,33,35 Two out of 3 studies 15,33,35 reported a significant difference in tunnel positioning in the sagittal plane, with AM-FR resulting in greater tunnel anteversion in these studies (Figure 3). 33,35 One out of 5 studies 15,20,21,23,33 reported a significant difference in tunnel positioning in the frontal or coronal plane, with AM-FR resulting in a less vertically oriented tunnel in this instance (Figure 3). 15 Four studies described femoral tunnel aperture morphology.…”

Section: Radiologic Outcomesmentioning

confidence: 96%

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Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review

Moran

Ignozzi

Werner

2021

Orthopaedic Journal of Sports Medicine

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Background: Recent studies have suggested that femoral tunnel drilling during anterior cruciate ligament (ACL) reconstruction (ACLR) with the use of a flexible reaming system through a standard anteromedial portal (AM-FR) may result in a different tunnel geometry compared with a rigid reamer through an accessory anteromedial portal with hyperflexion (AM-RR). Purpose: To summarize radiologic, anatomic, and clinical outcomes from available studies that directly compared the use of AM-FR versus AM-RR for independent femoral tunnel creation during ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using the MEDLINE (PubMed) and Web of Science databases to identify all studies that directly compared radiologic, anatomic, and clinical outcomes between the use of AM-FR and AM-RR. The literature search, data recording, and methodological quality assessment was performed by 2 independent reviewers. The outcomes analyzed included resultant ACL graft positioning and graft bending angle; femoral tunnel positioning, aperture morphology, length, and widening; posterior wall breakage; and distance from various posterolateral knee structures. Results: A total of 13 studies met the eligibility criteria for inclusion. There was no difference in femoral tunnel aperture location between techniques. There were conflicting findings among studies regarding which technique resulted in a more acute graft bending angle. One study reported greater femoral tunnel widening upon follow-up with the use of AM-FR. AM-FR produced longer and more anteverted femoral tunnels than did AM-RR. The difference in tunnel length was significant and more prominent in lesser degrees of knee flexion. With AM-FR, femoral tunnels were farther from the lateral collateral ligament and peroneal nerve, and 1 of 5 studies had fewer reports of posterior wall breakage. There has been no literature comparing the clinical or functional outcomes of these techniques. Conclusion: Although no clinical studies exist comparing AM-FR and AM-RR for femoral tunnel creation during ACLR, both systems allow for reproducible positioning of an anatomic femoral tunnel aperture. The use of AM-FR results in longer and more anteverted femoral tunnels than using AM-RR, with exit points on the lateral femur that are different but safe. Surgeons should be aware of the technical differences with each method; however, further study is needed to identify any clinically important difference that results.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Radiologic Outcomesmentioning

confidence: 96%

Section: Radiologic Outcomesmentioning

confidence: 96%

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Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review

Moran

Ignozzi

Werner

2021

Orthopaedic Journal of Sports Medicine

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“…Based on the complexity of the knee motion and soft tissue balancing of living subjects, data from actual ACL reconstruction may have more direct clinical relevance than the data from the operation using in-vitro cadaveric knee models. [ 11 , 12 ] Therefore, the aim of the present study is to compare the femoral tunnel characteristics using a rigid versus flexible reamer during single-bundle ACL reconstruction using a transportal technique. To accomplish this aim, we reconstructed three-dimensional (3D) knee models based on the in-vivo computerized tomography (CT) images of the operated knee from the patients who had undertaken the single-bundle ACL reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Effects of flexible reamer on the femoral tunnel characteristics in anterior cruciate ligament reconstruction

Seo

Song

et al. 2021

Medicine

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To compare the femoral tunnel characteristics using a rigid versus flexible reamer during anterior cruciate ligament reconstruction. It was hypothesized that the employment of a flexible reamer along with femoral tunnel would exhibit longer tunnel length and more acute femoral graft tunnel angle compared to the case of a rigid reamer.The study population included 28 patients who underwent anatomical single-bundle anterior cruciate ligament reconstruction using transportal technique and were able to take postoperative computed tomography (CT) evaluation. Of these, the femoral tunnel of 14 cases was drilled with a flexible reamer (group I) and in another 14 cases drill was performed with a conventional rigid reamer (group II). The femoral tunnel in group I was made at 90° of knee flexion. In group II, the femoral tunnel was created at 120° of knee flexion. The parameters of the femoral tunnels were compared in terms of the femoral tunnel length and femoral graft tunnel angle. Special software was used to create and manipulate (3-D) 3-dimensional knee models.The difference in the mean femoral tunnel locations expressed in percentage distance between the 2 groups was not significantly different. The mean femoral tunnel length of group I was significantly longer than that of group II, (P = .03, 36.7 ± 2.9 vs 32.9 ± 9.0 mm). The angle formed by the femoral tunnel and the graft in group I was significantly smaller than in group II (P = .01, 109.8° ± 9.4° vs 118.1° ± 7.2°).Our data suggest that the flexible reamer can provide sufficient tunnel length for the suspensory fixation with a fixed loop. Whereas, the femoral graft-tunnel angle through flexible reaming at 90° of knee flexion was more acute compared to rigid reaming at 120° of knee flexion.Study Design: level of evidence III

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Combined reconstruction of the posterior cruciate ligament and medial collateral ligament using a single femoral tunnel

Bonadio

Helito

Foni

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

Abstract: IV.

Cited by 9 publications

References 19 publications

Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review

Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review

Effects of flexible reamer on the femoral tunnel characteristics in anterior cruciate ligament reconstruction

Combined reconstruction of the posterior cruciate ligament and medial collateral ligament using a single femoral tunnel

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