Radiologic assessment of femoral and tibial tunnel placement based on anatomic landmarks in arthroscopic single bundle anterior cruciate ligament reconstruction

Abstract

Background:Accurate tibial and femoral tunnel placement has a significant effect on outcomes after anterior cruciate ligament reconstruction (ACLR). Postoperative radiographs provide a reliable and valid way for the assessment of anatomical tunnel placement after ACLR. The aim of this study was to examine the radiographic location of tibial and femoral tunnels in patients who underwent arthroscopic ACLR using anatomic landmarks. Patients who underwent arthroscopic ACLR from January 2014 to March 2016 were included in this retrospective cohort study.Materials and Methods:45 patients who underwent arthroscopic ACLR, postoperative radiographs were studied. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation and proportions as applicable. Interobserver agreement was measured using intraclass correlation coefficient.Results:The position of the tibial tunnel was found to be at an average of 35.1% ± 7.4% posterior from the anterior edge of the tibia. The femoral tunnel was found at an average of 30% ± 1% anterior to the posterior femoral cortex along the Blumensaat's line. Radiographic impingement was found in 34% of the patients. The roof angle averaged 34.3° ± 4.3°. The position of the tibial tunnel was found at an average of 44.16% ± 3.98% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 67.5° ± 8.9°. The coronal angle of the femoral tunnel averaged 41.9° ± 8.5°.Conclusions:The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients.

Accuracy of transportal femoral aimer in placement of femoral tunnel during arthroscopic anterior cruciate ligament reconstruction: An observational study

“…In this study, the mean tunnel location in AP plane (lateral X-ray view) was at 80.01% [Table 3], which was similar to the study of Pinczewski et al and Debnath et al [11,19] In contrast to our study, Nema et al placed femoral tunnels at an average of 69.41% ± 10.77% posterior along the Blumensaat's line, which was more anterior to ours. [20] While in Pinczewski et al study, the midpoint of the femoral tunnel was located at a mean of 86% ± 5% posteriorly along Blumensaat's line, which was more posterior than our study. [11] Harner et al in their study concluded that an ideal positioning of the femoral tunnel should be at approximately 80% of the AP length of the Blumensaat line, which was similar to our study.…”

“…[9] Studies have recommended placing the femoral tunnel at least 60-86% posterior along the Blumensaat's line. [11,[19][20][21] Considering this fact, we can conclude that 84% of tunnel made by combination of eyeballing and femoral offset aimer are correctly placed.…”

Radiological evaluation of tunnel position in single bundle anterior cruciate ligament reconstruction in the Indian population and their clinical correlation

“…2,6,11,18,19 To customize this concept to the Indian population there is insufficient information available in the literature. 20 The purpose of our study was to address this problem and find out what radiological positions of osseous tunnels are consistent with the optimum clinical outcome. Probably, this would also enable us to set a superior intraoperative reference guide to achieve more favorable clinical results after arthroscopic ACL reconstruction.…”

Side Variations of Anterior Cruciate Ligament Coronal Angles: Implications for ACL Reconstruction

“…Given variations in an individual's native ACL coronal angle of inclination, conversion of native coronal angle to appropriate tunnel angles is essential to create near identical anatomical ACL reconstruction. Nema et al () demonstrated coronal tibial tunnel angles averaging 67.5° ± 8.9° and a coronal angle of the femoral tunnel averaging 41.9° ± 8.5°. These tunnel placements demonstrated radiographic impingement in 34% of patients, demonstrating the importance of tunnel placement (Nema et al, ).…”

“…Nema et al () demonstrated coronal tibial tunnel angles averaging 67.5° ± 8.9° and a coronal angle of the femoral tunnel averaging 41.9° ± 8.5°. These tunnel placements demonstrated radiographic impingement in 34% of patients, demonstrating the importance of tunnel placement (Nema et al, ). Further assessment to establish the relationship between femoral and tibial tunnel angulation and the resulting coronal angle of inclination may continue to aid in efforts to reduced impingement and peak stress on the grafts.…”