Graft impingement in anterior cruciate ligament reconstruction

Iriuchishima, Takanori; Shirakura, Kenji; Fu, Freddie H.

doi:10.1007/s00167-012-2014-6

Cited by 70 publications

(66 citation statements)

References 38 publications

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“…Traditionally, non-anatomic ACL reconstructions were found to be only successful in restoring anteroposterior stability, but not rotational stability, resulting in a positive pivot shift [3,4]. Drilling of the femoral and tibial tunnels at native ACL insertion sites is considered a key factor to establish a more horizontal orientation that provides anteroposterior and rotational stability, and to prevent impingement of the graft against the intercondylar notch or posterior cruciate ligament (PCL) [5].…”

Section: Introductionmentioning

confidence: 99%

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Clockaerts¹,

Haver²,

Verhaegen³

et al. 2016

The Knee

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Section: Introductionmentioning

confidence: 99%

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Clockaerts¹,

Haver²,

Verhaegen³

et al. 2016

The Knee

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“…This impingement may progress to ACL degeneration and may alter knee biomechanics and proprioception. 1,11 However, although the notchplasty procedure and its relation to ACL reconstruction are well described, 2,6,[12][13][14][15][16][17] the effects of notchplasty in the setting of osteoarthritis remain unclear. Leon et al 1 described 4 types of intercondylar stenosis in knees associated with degenerative osteoarthritis based on anatomic findings.…”

Section: Discussionmentioning

confidence: 99%

Notchplasty for the Arthroscopic Treatment of Limited Knee Extension

Ferrari

Mannava

DePhillipo

et al. 2017

Arthroscopy Techniques

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Knee osteoarthritis may lead to narrowing of the intercondylar notch due to osteophyte formation, thereby causing changes in native knee biomechanics. The normal close contact between the condyles and the anterior cruciate ligament (ACL) during knee extension may be compromised due to narrowing of the notch and result in ACL damage, progression of knee osteoarthritis, and loss of knee extension. Outcomes after a notchplasty procedure are well reported for ACL reconstruction in young patients. However, there remains a lack of studies evaluating this procedure in the setting of knee osteoarthritis in patients with a symptomatic loss of knee extension. The purpose of this Technical Note is to present our preferred surgical technique for the treatment of loss of knee extension in the setting of knee osteoarthritis in conjunction with osteophyte formation in the intercondylar notch.T he anterior cruciate ligament (ACL) and the intercondylar notch area are in close contact when the knee is in full extension. Congruency and space between the ACL and intercondylar area is necessary to maintain knee range of motion during extension and prevent damage to intra-articular structures. Osteophyte formation of the femoral notch can lead to ACL damage, loss of knee extension, and gait alteration.

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“…While the above studies could possibly explain the positive functional outcomes in IKDC scores with an anteriorly placed tibial tunnel in our study, our intention was to place the tibial tunnel to the center of the native ACL foot print in all the cases. While there may be an anatomical or biomechanical advantage in terms of joint stability for an anteriorly placed tibial tunnel, clinical studies have reported complications such as graft impingement, loss of knee extension, and anterior knee pain with an anteriorly placed tibial tunnel 1617…”

Section: Discussionmentioning

confidence: 99%

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

Mathai¹,

Amaravathi

Pavan

et al. 2016

IJOO

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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.

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Graft impingement in anterior cruciate ligament reconstruction

Cited by 70 publications

References 38 publications

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Notchplasty for the Arthroscopic Treatment of Limited Knee Extension

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

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