Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions

Pietrini, Sean D.; Ziegler, Connor G.; Anderson, Christopher; Wijdicks, Coen A.; Westerhaus, Benjamin D.; Johansen, Steinar; Engebretsen, Lars; LaPrade, Robert F.

doi:10.1007/s00167-010-1372-1

Cited by 75 publications

(119 citation statements)

References 25 publications

(34 reference statements)

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“…The double-bundle measurements were measured from the centers of the AM and PL bundles, although some studies [5,19] further define the area of the footprint of the AM and PL bundles ( Table 1). The percent distance of the AM bundle from the posterior condylar line ranged from 15% (15 cadaveric knees) [11] to 31.9% (32 cadaveric knees) [25].…”

Section: Lateral Knee Radiographs Of the Femurmentioning

confidence: 99%

“…Pietrini et al showed that 115°of flexion was the point at which the bundles were aligned horizontally to the plane of the ground [19].…”

Section: Lateral Knee Radiographs Of the Femurmentioning

confidence: 99%

“…Pietrini et al also performed axial measurements of the tibia (Fig. 5) [19]. The center of the AM bundle was 48% along the maximum coronal diameter of the axial sections starting medially and 37.7% in reference to the anterior edge of the tibia along the maximum sagittal diameter.…”

Section: Ap Knee Radiographs Of the Tibiamentioning

confidence: 99%

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Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

et al. 2014

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Background: In an attempt to improve the accuracy and reproducibility of tunnel positioning, radiographs are being analyzed in an attempt to recreate the native anatomy of the ACL. Understanding the native ACL radiographic anatomy is an essential prerequisite to understand the relevance of postoperative tunnel position. Questions/ Purposes: We performed a systematic review of the literature to delineate the radiographic location of the native ACL femoral and tibial footprints. Methods: A search was performed in March 2014 in PubMed, the Cochrane Collaboration Library, and EMBASE to identify all studies that evaluated the native anterior cruciate ligament (ACL) anatomy on radiographs. Various measurement methods were used in each study, and averages were obtained of the data from studies with the same measurement methods. Results: Fifteen papers were identified (which included data on 177 femora and 207 tibiae in total). Evaluation of the femoral footprint using the quadrant method on lateral knee radiographs showed that the average percent distance location of the anteromedial (AM) bundle and posterolateral (PL) bundle was 22.8% (95% confidence interval (CI) 16.59-28.90) and 32.5% (95% CI 27.71-37.26) from the posterior condyle, respectively, and 23.2% (95% CI 19.52-26.94) and 50.0% (95% CI 46.16-53.76) from Blumensaat's line, respectively. Using the Amis and Jacob method, the tibial footprint on the lateral knee radiograph average percent distances was for the center of the AM bundle and 47.3% (95% CI 41.69-52.95) for the center of the PL bundle of the ACL. The femoral and tibial ACL footprints on the anteroposterior (AP) views of the knee were not well delineated by these studies. Conclusion: The information presented in this systematic review offers surgeons another important tool for accurate ACL footprint identification.

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Section: Lateral Knee Radiographs Of the Femurmentioning

confidence: 99%

“…Pietrini et al showed that 115°of flexion was the point at which the bundles were aligned horizontally to the plane of the ground [19].…”

Section: Lateral Knee Radiographs Of the Femurmentioning

confidence: 99%

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Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

et al. 2014

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“…Regardless of the surgical intervention method used, the key element in ACL surgery remains knee and ACL anatomy, which have been resolved thoroughly for the tibial and femoral sides [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The ACL has two bundles, anteromedial and posterolateral, the names given from the tibial insertion site.…”

Section: Introductionmentioning

confidence: 99%

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

Suomalainen

Kannus

Järvelä³

2012

International Orthopaedics (SICOT)

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Purpose Anterior cruciate ligament (ACL) reconstruction has been under intensive discussion and debate, although the anatomy of this ligament was resolved thoroughly almost 200 years ago. The ACL consist of two bundles, anteromedial (AM) and posterolateral (PL). The conventional single-bundle method reconstructs the AM bundle only, while the modern double-bundle technique recreates both bundles for their anatomical sites. Methods An English language literature search was undertaken over the years 2000-2012 for ACL reconstruction, double-bundle versus single bundle technique. The search found 14 RCTs and two meta-analyses published to date. Results Two of the 14 studies (14 %) showed no difference between the two reconstruction methods while the remaining majority (12 trials, 86 %) concluded that the DB technique was better than the SB method. After the DB reconstruction, rotational stability of the knee was better in seven studies (50 %) and anteroposterior stability in six (43 %). No study spoke for the single-bundle technique. In addition, with the double-bundle technique knee scores were reported to be better in five (36 %) studies, and three trials (21 %) revealed less reoperations in the double-bundle group. Conclusions The double-bundle ACL reconstruction technique was reported to have better or at least the same results as the conventional single-bundle method-even at a fiveyear follow-up. However, the majority of these studies had a rather short follow-up, and thus, longer studies are needed to confirm the true long-term results of ACL surgery. Long follow-up periods are also needed to find out whether double-bundle ACL reconstruction can eventually prevent knee osteoarthritis.

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“…[5][6][7] The center of the entire tibial footprint has been estimated to be at the midpoint of the centers of the 2 bundles at 44% (anterior to posterior). 8,9 Keeping this in view, we tried to use intraoperative fluoroscopy (C-arm) for accurately localizing the starting point of our tunnel.…”

mentioning

confidence: 99%

Accurate Positioning of Femoral and Tibial Tunnels in Single Bundle Anterior Cruciate Ligament Reconstruction Using the Indigenously Made Bernard and Hurtle Grid on a Transparency Sheet and C-arm

Kumar

2017

Arthroscopy Techniques

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Many factors determine the outcome of the anterior cruciate ligament reconstruction surgery. The single most important factor, also well within the control of a surgeon, is tunnel placement. It is difficult to accurately determine the center of the anterior cruciate ligament foot print, and many a times it is also difficult to accurately define the intercondylar and bifurcate ridge. This makes determination of the accurate entry point of the guidewire difficult. We have printed our indigenously formed grid (equidistant boxes) on an old-fashioned transparency sheet. We use a fluoroscopy (C-arm) shot intraoperatively in the lateral position and superimpose this sheet to determine the position of the guidewire by calculating the percentage of boxes. We aim at 27.7% in proximal to distal and 37.5% in anterior to posterior on the femur side and 45% in front to back and medial to lateral on the tibial side. C-arm is freely available, but the inbuilt grid facility may be available in only the higher version of C-arms. Our indigenously designed grid can be easily used across the globe with ease to achieve accuracy in tunnel placement without violating anatomy and without any extra cost.

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Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions

Cited by 75 publications

References 25 publications

Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

Accurate Positioning of Femoral and Tibial Tunnels in Single Bundle Anterior Cruciate Ligament Reconstruction Using the Indigenously Made Bernard and Hurtle Grid on a Transparency Sheet and C-arm

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