Positioning of the tibial tunnel for anterior cruciate ligament reconstruction

Goble, E. Marlowe; Downey, Daniel J.; Wilcox, Todd

doi:10.1016/0749-8063(95)90111-6

Cited by 54 publications

(27 citation statements)

References 10 publications

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“…Thereby, the method of locating attachment site during operation is important. Fluoroscopically-assisted locating methods have been reported to increase the accuracy of graft placement [1,3,8,10,21,23], and they are especially helpful to locate the femoral tunnel [17]. Of the most frequently used methods, Amis' method has been proven to be more accurate and repeatable than Harners and Aglieffi's [21].…”

Section: Discussionmentioning

confidence: 99%

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Guo

Yang

Wang

et al. 2008

International Orthopaedics (SICO

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The purpose of this study was to determine the relationships of the anterior cruciate ligament (ACL) femoral insertion site with femoral bony landmarks and develop a new method of location. Sixteen unpaired normal Chinese human cadaveric knees were used. Femoral insertion sites of the ACL were marked with metal wires. Four pairs of bony landmarks were selected: anatomical axis of distal femur (A) and parallel tangent of posterior condyles (B); tangent of anterior condyles parallel to landmark A (C) and landmark B; Blumensaat's line (D) and parallel tangent of distal condyles (E); and tangent of posterior condyles (F) and parallel tangent of anterior condyles (G). The X-Caliper was used to measure the distance between the centre of the insertion site and each pair of bony landmarks. The ratio of distances to each pair of bony landmark was calculated. Clock position of the ACL femoral footprint was measured on anteroposterior (AP) roentgenograms at 90 degree flexion. The centre of the ACL footprint was found at 65.3% ± 1.1% between A and B, 78.1% ± 1.0% between B and C, 38.3% ± 2.7% between D and E, and 43.1% ± 4.6% between F and G. The distances to bony landmarks A, B, D, and E have smaller variations. Blumensaat's line and the anatomical axis of the distal femur were regarded as more useful and made location of the insertion site more precise. A parallelogram made up of these two bony landmarks can be used. On AP roentgenograms, the centre of the femoral footprint should be moved to lower than the 10:00 o'clock (2:00) position.

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Section: Discussionmentioning

confidence: 99%

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Guo

Yang

Wang

et al. 2008

International Orthopaedics (SICO

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“…Doubled grafts of the tibialis anterior tendon (CryoLife, Marietta, GA) were prepared, using 2 braided polyblend sutures (AR-7200, FiberWire, Arthrex, Naples, FL) and standard techniques (Charlick and Caborn 2000). Tunnels were drilled at 50 degrees retrograde to the anterior tibial surface, with an initial diameter of 2 mm less than that of the grafts (Goble et al 1995, Howell et al 1999. The tunnels were then dilated to have the same diameters as the graft.…”

Section: Methodsmentioning

confidence: 99%

Tendon graft fixation in ACL reconstructionIn vitro evaluation of bioabsorbable tenodesis screw

Klein

Nyland

Kocabey

et al. 2004

Acta Orthopaedica Scandinavica

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Background Conventional ACL reconstruction requires sufficient tibial bone quality for secure graft fixation. We evaluated the mechanical characteristics of a supplemental tenodesis screw in cadaveric specimens.Material and methods One group of 7 specimens from 7-paired tibiae was randomly assigned to undergo tibialis anterior tendon graft-bone tunnel fixation with a bioabsorbable interference screw, using conventional ACL reconstruction techniques. The other group of 7 specimens underwent the same procedure supplemented with a bioabsorbable tenodesis screw. All specimens were subjected to pullout testing on a servo hydraulic device.Results Specimens in the supplemental fixation group had double the load to failure (tenodesis = 467 (SD 184) N, control group = 223 (SD 66) N, p = 0.02) and were also one-third stiffer (tenodesis = 31 (SD 13) N/mm, control group = 21 (SD 6) N/mm, p = 0.03) than the specimens in the conventional fixation group.Interpretation Supplemental bioabsorbable tenodesis screw fixation may be advantageous for primary reconstruction in patients with low tibial bone mineral density or during revision procedures. By providing secure soft tissue graft-tibia fixation during the early phase after ACL reconstruction, supplemental tenodesis fixation may enable patients to participate safely in more intense, early rehabilitation.

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“…We believe the reason why intraarticular techniques in dogs, especially those that make use of bone tunnels, fail at restoring normal stifle kinematics may be related to the combination of improper graft selection and tunnel misplacement 3,15,16 . Misplacement of the tibial tunnel will either cause excessive tension on the transplant promoting graft failure and recurrent instability, or it will result in loss of tension within the graft during the range of motion of the stifle, and therefore fail at restoring joint stability 17–23 . Impingement of the graft at the intercondylar roof at the extension of the joint is another serious complication, resulting mainly from tibial tunnel placement too far cranially 19,24–26 .…”

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confidence: 99%

Development and In Situ Application of an Adjustable Aiming Device to Guide Extra‐ to Intraarticular Tibial Tunnel Drilling for the Insertion of the Cranial Cruciate Ligament in Dogs

et al. 2010

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Positioning of the tibial tunnel for anterior cruciate ligament reconstruction

Cited by 54 publications

References 10 publications

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper

Tendon graft fixation in ACL reconstructionIn vitro evaluation of bioabsorbable tenodesis screw

Development and In Situ Application of an Adjustable Aiming Device to Guide Extra‐ to Intraarticular Tibial Tunnel Drilling for the Insertion of the Cranial Cruciate Ligament in Dogs

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