Risk of Iatrogenic Injury to the Peroneal Nerve during Posterolateral Femoral Tunnel Placement in Double-Bundle Anterior Cruciate Ligament Reconstruction

Hall, Michael; Ryzewicz, Mark; Walsh, Pamela; Sherman, Orrin H.

doi:10.1177/0363546508324177

Cited by 37 publications

(35 citation statements)

References 24 publications

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“…During this travelling fellowship, the majority of the femoral tunnels were drilled independently from the anteromedial portal (Figure 2). The key concerns with anteromedial portal drilling are: short femoral tunnel length, injury to the cartilage, injury to posterolateral knee structures and posterior wall blow-out [70-72]. …”

Section: Discussionmentioning

confidence: 99%

A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

Lee

Kuroda

Zhao

et al. 2012

BMC Sports Sci Med Rehabil

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The purpose of ESSKA- APOSSM Travelling fellowship is to better understand the epidemiology, management and surgical techniques for sports across continents. There has been a progressive evolution in ACL reconstruction and there is variation in technique in ACL reconstruction amongst the most experienced surgeons in different continents. During this one month fellowship, we saw various ACL reconstruction techniques using different graft sources, with a variety of graft fixation methods, with the common aim of recreating an anatomical ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

Lee

Kuroda

Zhao

et al. 2012

BMC Sports Sci Med Rehabil

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“…Cadaveric studies have shown that the risk of common peroneal nerve injury significantly increases when creating femoral tunnels through the low-accessory anteromedial portal at a low angle such as 70°of knee flexion. For that reason, a higher angle of more than 110°of knee flexion is recommended to avoid peroneal nerve injury when creating a femoral tunnel through the low medial accessory portal [65,66]. Surgeons should consider those risks during drilling.…”

Section: Drilling Tunnelsmentioning

confidence: 99%

Anatomic double-bundle anterior crucial ligament reconstruction with G-ST

Kuroda

Matsushita

2011

Curr Rev Musculoskelet Med

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The anterior cruciate ligament (ACL) consists of two primal functional bundles, anteromedial bundle and posterolateral bundles. Those two bundles play different functional roles and contribute differently to knee stability throughout the range of motion. Recent advancement in studies of anatomy and biomechanics of ACL has led surgeons to perform double-bundle ACL reconstruction to obtain better stability and kinematics. Consequently, variable surgical techniques of double-bundle ACL reconstruction have been reported to replicate native ACL. In addition, various surgical key points and problems in double-bundle ACL reconstruction techniques have also been reported. There has been a trend to more anatomically replicate native ACL bundles, not simply creating two bundles. We summarize the basic knowledge and current concepts of anatomic double-bundle ACL reconstruction using hamstrings tendons.

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“…In a laboratory setting, flexion of the knee to a minimum of 110 degrees and preferably over 120 degrees was necessary to obviate this possibility. 10,11 Clinically, there is slight variability in knee anatomy and in anteromedial portal placement that can impact these measurements. It is preferable to place the anteromedial portal just superior to the tibial plateau and just lateral to the medial condyle.…”

Section: Central Anatomic Single-bundle Surgical Techniquementioning

confidence: 99%

Anatomic Single-bundle ACL Reconstruction

Steiner

2009

Sports Medicine and Arthroscopy Review

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A critical evaluation of anterior cruciate ligament (ACL) reconstruction techniques has revealed that single-bundle grafts placed by conventional transtibial drilling do not provide adequate restraint to translational and rotatory forces. In some knees, this will affect function and possibly contribute to chondral injuries. The method of 2-bundle ACL reconstruction has evolved partly to address these concerns with the premise that greater rotational stability will be provided by 2-bundle grafts. Although the question of what constitutes rotational stability is still debated, the methodology of 2-bundle ACL reconstructions has clearly reinforced the need to center grafts within the native ACL insertions. When the principles of anatomic graft placement are combined with an independent drilling method, then single-bundle grafts can restore physiologic laxity to the knee. A thorough knowledge of the ACL insertions is necessary and an independent drilling method using an anteromedial portal is required. The technique for anteromedial portal drilling requires adjustments to permit knee flexion over 125 degrees when drilling. Grafts positioned in this fashion will tend to lengthen in extension and fixation may be accomplished with the knee in close to full extension.

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Risk of Iatrogenic Injury to the Peroneal Nerve during Posterolateral Femoral Tunnel Placement in Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract: During posterolateral femoral tunnel placement, the risk of injury to the common peroneal nerve is minimal but is increased as the knee is placed in less flexion. Guide pin placement at knee flexion of 120 degrees is recommended to ensure safety of the peroneal nerve and the biceps tendon.

Cited by 37 publications

References 24 publications

A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

Anatomic double-bundle anterior crucial ligament reconstruction with G-ST

Anatomic Single-bundle ACL Reconstruction

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