Factors affecting isometry of endoscopic anterior cruciate ligament reconstruction: the effect of guide offset and rotation

Cooper, Daniel E.; Urrea, Luis; Small, John

doi:10.1016/s0749-8063(98)70035-0

Cited by 19 publications

(20 citation statements)

References 15 publications

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“…[43][44][45][46][47][48][49] They noted similar findings to our study with graft lengths and forces decreasing with knee flexion from 0-degree extension and eventually increasing again with deeper knee flexion angles. 11,21, [43][44][45][46][47][48][49] All of these studies evaluated transtibial tunnel drilling except Sim et al who evaluated AM portal, outside-in, and transtibial femoral drilling techniques with hamstring grafts. They found that graft forces were no different from native ACL forces.…”

Section: Discussionsupporting

confidence: 89%

“…An actual graft composed of multiple fibers and bundles may have behaved differently from the smaller diameter FiberWire, and it is known that different locations within a transtibial graft see different forces and length changes. 43,44,48 It would not have been possible to use actual tunnels and grafts for each of the three techniques on each specimen, though we feel that our method is a reasonable compromise. When measuring tension, the initial tension was set in full extension as opposed to 30degree flexion or some other angle as may be done during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Anterior Cruciate Ligament Graft Isometry Is Affected by the Orientation of the Femoral Tunnel

et al. 2015

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Graft Isometry Is Affected by the Orientation of the Femoral Tunnel

et al. 2015

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“…It has been recommended in the literature to leave 6 mm of clearance between the anterior aspect of the graft and the intercondylar roof during extension of the knee. Arthroscopically, the bone tunnel should be drilled at an angle of 40°–50° to the long axis of the tibia and should be placed anteromedially or posterior to the anterior horn of the medial meniscus and slightly anterior to the posterior cruciate ligament insertion [ 76 – 79 ].…”

Section: Principles Of Acl Reconstructionmentioning

confidence: 99%

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction

Dargel¹,

Gotter²,

Mader³

et al. 2007

Strategies in Trauma and Limb Reconstruction

160

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identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages midto long-term clinical and functional outcomes after ACL reconstruction. Key words Anterior cruciate ligament • ACL reconstruction • Biomechanics • Graft fixation • Graft tension IntroductionThe anterior cruciate ligament (ACL) is one of the most frequently injured structures of the knee joint [1]. Because of its key function as the primary restraint against anterior tibial translation, ACL disruption inevitably causes alterations in knee kinematics which are most likely to result in secondary degenerative changes and long-term functional impairment [2, 3]. As the ACL fails to heal in a manner that would restore normal knee kinematics, reconstructive techniques have been emphasised for patients who desire restoration of knee function and stability as well as return to high-level physical performance [4]. Although current concepts in knee ligament repair are reported to be clinically successful in most trials, ACL reconstruction has failed from a biomechanical point of view to both fully restore normal knee kinematics and to anatomically mimic the native ACL. Therefore, it may be postulated that surgi- Abstract Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been

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“…The isometry is widely influenced by femoral tunnel placement. Studies evaluating isometric placement of graft have suggested that the 12-o'clock position with a 2 mm of posterior wall was the most isometric [27], but this position results in a vertically oriented non-anatomic graft [28]. In such situation the anterior stability of the knee is partially controlled, but rotational stability remained uncontrolled, resulting in a persistent pivot shift with consequent pathologic knee kinematics that can be associated with a poorer outcome and long-term arthritis [6,8,29].…”

Section: Introductionmentioning

confidence: 99%

“…Hefzy et al [21] noted a larger isometric (2 mm) zone superiorly and proximally, so most authors are recommending an entry point high in the notch, at the 11 o'clock position for a right knee with 1 to 2 mm posterior cortical shell, and often this requires the use of a more inferior anteromedial portal resulting in a more demanding technique [30]. However, the current method used to place the femoral tunnel in the 11 o'clock position seems to be inaccurate and moreover analysis of literature shows that the ACL isometry is a theoretical condition, and has not stood up to detailed testing and investigation [22,26,27]. …”

Section: Introductionmentioning

confidence: 99%

Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique

Garofalo

Moretti

Kombot³

et al. 2007

J Orthop Surg Res

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Endoscopic anterior cruciate ligament (ACL) reconstruction can be performed through oneincision or two-incision technique. The current one-incision endoscopic ACL single bundle reconstruction techniques attempt to perform an isometric repair placing the graft along the roof of the intercondylar notch, anterior and superior to the native ACL insertion. However the ACL isometry is a theoretical condition, and has not stood up to detailed testing and investigation. Moreover this type of reconstruction results in a vertically oriented non-anatomic graft, which is able to control anterior tibial translation but not the rotational component of the instability. Femoral tunnel obliquity has a great effect on rotational stability. To improve the obliquity of graft, an anatomical ACL reconstruction should be attempt. Anatomical insertion of ACL on the femur lies very low in the notch, spreading between 11 and 9-8 o'clock position and the center lies lower than at 11 o'clock position. Femoral aiming devices through the tibial tunnel aim at an isometric placement, and they do not aim at an anatomic position of the graft. Also, a placement of tunnel in a position of 11 o'clock is unable to restore rotational stability. The two-incision technique, with the possibility to position femoral tunnel independently by tibial tunnel, allows us to place femoral tunnel entrance in a position of 10 'clock that can most accurately reproduce the anatomic behaviour of the ACL and can potentially improve the response of the graft to rotatory loads. This positioning results in a more oblique graft placement, avoiding problem related to PCL impingement during knee flexion. Further studies are required to understand if this kind of reconstruction can ameliorate proprioception as well as clinical outcome at a long-term follow-up.

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Factors affecting isometry of endoscopic anterior cruciate ligament reconstruction: the effect of guide offset and rotation

Cited by 19 publications

References 15 publications

Anterior Cruciate Ligament Graft Isometry Is Affected by the Orientation of the Femoral Tunnel

Anterior Cruciate Ligament Graft Isometry Is Affected by the Orientation of the Femoral Tunnel

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction

Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique

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