Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-In Single-Bundle Anterior Cruciate Ligament Reconstruction

Osti, Michael; Krawinkel, Alessa; Ostermann, Michael; Hoffelner, Thomas; Benedetto, K. P.

doi:10.1177/0363546515590221

Cited by 67 publications

(60 citation statements)

References 42 publications

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“…These different results may be caused by a less-standard starting point of the tibial tunnel, which remained compromised with nonanatomic ACL reconstruction. In contrast, of the 19 studies with anatomic ACL reconstruction, only two [24,28] demonstrated that the angle of the femoral tunnel in the coronal plane was less than 30˚, thus showing a much more oblique tunnel than in the studies quoted previously that used anatomic ACL reconstruction. Therefore, a considerably oblique femoral tunnel angle, which may result in more repetitive bending stress on the graft at the femoral tunnel opening, should be avoided because of increased abrasive force at the contact area on the sharp edge of the bone tunnel opening.…”

Section: Plos Onementioning

confidence: 63%

Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

et al. 2020

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Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. Materials and method In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. Results Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10-10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29˚(95% CI: 8.07˚-22.52˚; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69-11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95%

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Section: Plos Onementioning

confidence: 63%

Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

et al. 2020

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“…Another possible explanation for our results is that, during femoral tunnel placement with the conventional transtibial technique, the guide pin and drill often need to be torqued and drilling is not concentric; in the outside-in technique, femoral tunnel placement is not forced by the tibial tunnel, as shown by Chambra et al [23]. Moreover, in a recent cadaveric study, Osti et al [24] showed that the outside-in portal surgical technique was superior at positioning the ACL femoral tunnel at the center of the native attachment site when compared with the standard transtibial technique. In fact, drilling the femoral tunnel separately from and unrelated to the tibial tunnel could achieve a more anatomical femoral insertion.…”

Section: Discussionmentioning

confidence: 68%

Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

Lanzetti¹,

Lupariello²,

Carli³

et al. 2017

Eur J Orthop Surg Traumatol

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“…Transportal, transtibial, and outside-in techniques are the most popularly used methods. 28,74,79,87,97 The transportal technique can easily reach the center of the native ACL footprint. However, deep-knee bending is required when creating the femoral tunnel using this method, and insufficient femoral tunnel length and iatrogenic femoral chondral tear are potential complications.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

Iriuchishima¹,

Goto²

2020

J Knee Surg

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The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms “anterior cruciate ligament reconstruction,” “anatomic or anatomical,” and “single bundle.” Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow–deep direction (32.3%) and in a high–low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.

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Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-In Single-Bundle Anterior Cruciate Ligament Reconstruction

Abstract: The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques.

Cited by 67 publications

References 42 publications

Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

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