Abstract:Grafts placed too anteriorly on the femur are reportedly a common cause of failure in anterior cruciate ligament reconstruction. Some studies suggest more anatomic femoral tunnel placement improves kinematics. The ability of the transtibial technique and a tibial tunnel-independent technique (placed transfemorally outside-in) to place the guide pin near the center of the femoral attachment of the anterior cruciate ligament was compared in 12 cadavers. After arthroscopic placement of the guide pins, the femur w… Show more
“…1, C). These findings are consistent with prior cadaver studies that evaluated tunnel position in traditional transtibial anterior cruciate ligament reconstruction [5][6][7][8] . In those studies, the tunnels were drilled during arthroscopy or in an open fashion and were evaluated postoperatively during dissection.…”
“…1, C). These findings are consistent with prior cadaver studies that evaluated tunnel position in traditional transtibial anterior cruciate ligament reconstruction [5][6][7][8] . In those studies, the tunnels were drilled during arthroscopy or in an open fashion and were evaluated postoperatively during dissection.…”
“…Drilling can be undertaken through an accessory AM portal or with our TransLateral technique. 30 ACL footprint anatomy has been defined, 42 and identification of the mid-bundle position on the femur can be achieved with the direct measurement technique, which has been validated. 32 Biomechanical testing has shown that single-bundle anatomic positioning confers advantages over traditional graft placement, but further improvements may be obtained by double-bundle reconstruction.…”
Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of doubleetibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.
“…In a recent study by Kaseta et al [11], more anatomic placement of the femoral tunnel was achieved using the femoral footprint as a landmark than with the over-the-top positioning guide, which resulted in femoral tunnel placement that was typically too anterior.…”
The presence of remnant tibial and femoral attachments of the ruptured ACL has been described in the literature but the femoral remnant has not been well described as a landmark for tunnel placement during reconstruction. We reviewed operative reports, pictures, and videotapes from 111 ACL reconstructions to determine the incidence of a remnant femoral stump. Patients were divided into two groups: Group A included patients
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