Optimal Femoral Tunnel Positioning in Posterior Cruciate Ligament Reconstruction Using Outside-in Drilling

Yi, Anthony; Kleiner, Matthew T.; Lorenzana, Dan; Koniceck, John; Charlton, Timothy P.; Hatch, George F. Rick

doi:10.1016/j.arthro.2014.12.002

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Furthermore, the relationship between the femoral tunnel outlet and the at-risk structures on the medial and posteromedial aspects of the femur was thoroughly investigated in this study. It was demonstrated that the femoral tunnel for PCLR should be positioned at an angle of 15° in the axial plane, as reported by Yi et al [14]. However, based on the same selected reference as Yi et al in the axial plane, our research showed that it would increase the risk of injury to the MCL or other at-risk structures if the femoral tunnel was placed at 15° in the axial plane (Fig.…”

Section: Discussionsupporting

confidence: 67%

“…In this study, the drilling orientation of the femoral tunnel was an independent variable. The angle combination method was applied by referring to two planes and speciic anatomical landmarks to measure and describe the tunnel orientations [14,33,34]. After palpation and observation, two markers were inserted at each epicondyle of the femur to outline the transepicondylar axis [35], and the line parallel to the transepicondylar axis served as the 0° reference angulation in the axial plane.…”

Section: Exploring the Correlation Between Tunnel Orientation And The...mentioning

confidence: 99%

“…In recent years, the issue of the security of bone tunnel drilling during ligament reconstruction has received signiicant attention [7][8][9][10][11]. In terms of femoral tunnel positioning for PCLR, most studies have focused on tunnel length, graft ixation angles, and knee kinematics [12][13][14][15], whereas the security of the tunnel has not been frequently raised. Chia et al investigated the risk of vascular injury when creating a femoral tunnel for PCLR by measuring the distance between the femoral tunnel outlet and the femoral artery [16].…”

Section: Introductionmentioning

confidence: 99%

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Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Guo

Zhang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the relationship between the medial and posteromedial femoral anatomic structures and the femoral tunnel exit produced by different tunnel orientations when creating the femoral tunnel for posterior cruciate ligament reconstruction (PCLR) using the inside‐out (IO) technique and to estimate safe tunnel orientations to minimize the risk of iatrogenic injury to these structures. MethodsEleven cadaveric knees were used. The medial and posteromedial aspects of each knee joint were dissected to reveal the "safe zone," which is a bony area that avoids the distribution or attachment of at‐risk structures (MCL, PMC structures, and articular cartilage), while remaining 10 mm away from the articular cartilage. The hypothesis of this study was that by creating the femoral tunnel at specific angles using the IO technique, the tunnel outlet would be as close to the safe zone as possible, protecting the at‐risk structures from damage. Femoral tunnels were drilled at 20 different angle combinations on each specimen: 0°, 15°, 30°, 45°, and 60° relative to a line parallel to the transepicondylar axis in the axial plane, as well as 15°, 30°, 45°, and 60° relative to a line parallel to the femoral axis in the coronal plane. The positional relationship between each tunnel exit and the safe zone was recorded, and the shortest distance between the exit center and the safe zone boundary was measured. ResultsThe risk of iatrogenic injury differed depending on the drilling orientation (χ2 = 168.880, P < 0.001). Femoral drilling angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/coronal) were considered relatively safer than other orientations (P < 0.05). The shortest distance between the tunnel exit and the safe zone boundary was negatively correlated with the angle in the axial plane (P < 0.001, r = − 0.810). ConclusionsWhen creating the IO femoral tunnel for single‐bundle PCL reconstruction, angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/oblique coronal) could be utilized to prevent at‐risk structures from being damaged. The drilling angles and the safe zone can be employed to optimize the femoral tunnel in PCLR.

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Section: Discussionsupporting

confidence: 67%

Section: Exploring the Correlation Between Tunnel Orientation And The...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Guo

Zhang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…A paired t test was used to compare the 2/10 and 1/11 femoral tunnel positions. Six specimens were then evaluated at the 1/11 femoral tunnel position since it’s traditionally used as the location for femoral tunnel placement during PCL reconstruction 21 , 22 and load cell recordings were obtained at 10 different knee flexion angles. Starting from full extension and verified with a goniometer, the knee samples were moved in 15° increments to 135° of flexion, with load cell readings recorded at each increment.…”

Section: Methodsmentioning

confidence: 99%

“…The 1/11 o’clock position was used for biomechanical testing, since it is traditionally used as the location for femoral tunnel placement during PCL reconstruction. 21 , 22 One-way repeated-measures analyses of variance (ANOVAs) were performed using SigmaPlot software (Systat Software, Inc., version 14, San Jose, CA) with an alpha = 0.05 to compare the displacement, translation, and stiffness of the intact, resected, and repaired sample groups. A post-hoc analysis of the data demonstrated that three of the 4 repeated-measures ANOVAs on cyclic displacement and stiffness had a power greater than 0.8, indicating that the sample size tested was sufficient to detect differences.…”

Section: Methodsmentioning

confidence: 99%

Suture Tape–Augmented Posterior Cruciate Ligament Repair Should Be Tensioned and Fixed at Approximately 100° Knee Flexion to Prevent Loss of Full Flexion

Ostrander

Jordan

Konicek

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the biomechanics of simulated posterior cruciate ligament injuries (SimPCL) with and without internal brace suture tape augmentation (IBSTA) in cadaver knees. Methods A total of 20 cadaveric knees were used, all male, with an average age of 65 ± 18 years. Femoral tunnel isometry was evaluated at the 1/11 o’clock and 2/10 o’clock femoral positions. SimPCL were created in 6 knees. IBSTA was performed, and load data were collected through knee range of motion. An additional 6 specimens were evaluated at the 1/11 femoral tunnel position, and load cell recordings were obtained at 10 different knee flexion angles. Cyclic displacement in 8 cadaver knees was assessed using an Instron machine. Load and displacement data were recorded. Testing was performed under 3 conditions for each specimen: intact PCL, SimPCL, and SimPCL/IBSTA using the 1/11 femoral tunnel position. Results There was no difference in isometry when comparing the 1/11 o’clock (7.1 ± 4.0 ft∗lb) femoral position and the 2/10 o’clock (7.6 ± 4.2 ft∗lb) position ( P = .467). SimPCL/IBSTA suture tape tension gradually increased with progressive flexion to a peak at approximately 120° of knee flexion. For cycle 100 tibial displacement, there was no difference between intact (4.41 mm) and SimPCL/IBSTA (5.59 mm, P = .391). There was a difference between intact (4.41 mm) and SimPCL (7.19 mm, P = .006) , but there was no significant difference between SimPCL/IBSTA (5.59 mm) and SimPCL (7.19 mm, P = .140). There was a difference in cycle 1 stiffness between intact (62.3 N/mm) and Sim2PCL (37 N/mm, P = .005). There was no difference between other groups. Conclusions In this cadaver study, there was a 1.18-mm average difference in posterior tibial displacement when comparing intact and SimPCL/IBSTA. The internal brace construct should be tensioned and fixed at approximately 100° of knee flexion to prevent loss of full flexion. Clinical Relevance The presented biomechanical data for internal bracing of PCL injuries may lead to improved surgical techniques.

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Evaluating the Femoral-Side Critical Corner in Posterior Cruciate Ligament Reconstruction: The Effect of Outside-In Versus Inside-Out Creation of Femoral Tunnels on Graft Contact Pressure in a Synthetic Knee Model

Narvy

Hatch

Ihn

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Optimal Femoral Tunnel Positioning in Posterior Cruciate Ligament Reconstruction Using Outside-in Drilling

Cited by 6 publications

References 28 publications

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

Suture Tape–Augmented Posterior Cruciate Ligament Repair Should Be Tensioned and Fixed at Approximately 100° Knee Flexion to Prevent Loss of Full Flexion

Evaluating the Femoral-Side Critical Corner in Posterior Cruciate Ligament Reconstruction: The Effect of Outside-In Versus Inside-Out Creation of Femoral Tunnels on Graft Contact Pressure in a Synthetic Knee Model

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