Functional and computed tomography correlation of femoral and tibial tunnels in single-bundle anterior cruciate ligament reconstruction

Abstract

Background:An accessory anteromedial portal (AAMP) has been shown to be effective in placing an anatomically ideal femoral tunnel. It is well known that this is due to the independent femoral drilling which is possible with the AAMP. However very little is known regarding the significance of this reconstruction technique in influencing the functional outcomes of anatomic anterior cruciate ligament reconstruction (ACLR). This study documents the influence of tibial and femoral tunnel positions on functional outcomes of anatomic ACLR using the AAMP.Materials and Methods:41 patients who underwent anatomic ACLR between 2011 and 2013 were included in this prospective cohort study. The primary outcome involved the documentation of femoral and tibial tunnel positions with volume rendering imaging using a three-dimensional computed tomography (3D-CT) done at the end of 1 year. The tunnel position evaluations from the CT images were performed by an independent observer specializing in radiodiagnosis. Functional outcome measures included preoperative and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores (subjective) documented by an independent investigator who was not involved with the surgical procedure, at the end of 1 year.Results:The minimum followup was 1 year. All patients achieved good clinical and functional outcomes postoperatively with no reported complications. Tunnel position evaluations with 3D-CT revealed the average tibial tunnel distance to be 15.5 mm (standard deviation [SD] =2.52) from the anterior border of the tibial plateau and the average femoral tunnel distance to be 14.33 mm (SD = 2.6) from the inferior margin of the medial surface of lateral femoral condyle and 13.72 mm (SD = 2.8) from the posterior margin of the medial surface of lateral femoral condyle. The average tunnel diameters were found to be 7.9 mm (SD = 0.72) for the tibial tunnels and 8.6 mm (SD = 1.07) for the femoral tunnels. Statistically significant correlation between the tibial tunnel distance and the IKDC scores with anterior placement of tibial tunnel were found; however, no such statistical relationship were found between the femoral tunnel positions and the functional outcome measures.Conclusion:AAMP gives an ideal approach to drill the femoral tunnel independently. However, the influence of this tunnel placement on long term functional outcomes of ACLR needs to be assessed on larger cohort of patients.

Arthroscopic Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Quadrupled Hamstring Tendon Graft: A Single-Institution Experience From North-Eastern India

“…In our study, there were no intraoperative and postoperative complications similar to those reported by Zhang et al [ 29 ] and Mathai et al [ 30 ]. Kumar et al [ 31 ] reported complications in seven patients (stiffness in two patients, infection in two, femoral tunnel blow-out in one, and graft re-rupture in one patient) with a minimum of 24 months of follow-up, which is longer than our study.…”

“…The baseline demographic data, i.e., mean age, ranged between 26.83 ± 7.50 years, which was similar to previous studies [29][30][31]. The age group of fewer than 30 years comprised 22 patients (75.87%), confirming the association of ACL years, especially in young individuals.…”

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

“…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. 36,56,64,67,82,91 The transtibial technique is the most traditional technique used to create the femoral ACL tunnel. Although, there is no need to worry about the iatrogenic problems that are potential complica-tions in the transportal technique, it is relatively demanding to reach the center of the native ACL footprint using this technique.…”