The Effects of Extra-articular Starting Point and Transtibial Femoral Drilling on the Intra-articular Aperture of the Tibial Tunnel in ACL Reconstruction

Abstract

We observed significantly increased tibial aperture size and shape after transtibial femoral drilling with a medial tibial starting point. Medial tibial tunnels, compared with more central tunnels, resulted in a more acute tibial tunnel in the coronal plane and less acute tibial tunnels relative to the sagittal plane. Medial tibial tunnels started farther from the tibial tubercle but ended farther from the medial joint line and closer to the anterior edge of the tibia in comparison to central tunnels Clinical Relevance Femoral tunnel placements may be best accomplished using a technique other than transtibial drilling through a medial tibial tunnel. Tibial tunnel angle, intra-articular position, and femoral tunnel placement are affected by the choice of extra-articular starting position.

Anteromedial versus central single-bundle graft position: which anatomic graft position to choose?

“…However, typical graft sizes for autograft single-bundle reconstruction are between 7-9 mm for soft tissue grafts and 9-11 mm for bone-tendon grafts. The native footprint can, therefore, only partially be filled with graft tissue, unless a reconstruction technique is chosen that sufficiently reproduces both the AM and the PL bundle [24] or that utilizes a shallow tibial tunnel angle to produce an oval (and larger) tibial tunnel aperture [18].…”

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

“…Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed outpatient orthopaedic surgeries in the United States and is typically performed in the setting of sports injuries [18,24,26,30,31]. Because many patients who undergo these procedures are young and active, surgical stabilization of the knee is an attractive option [1,18,25,41].…”

Contemporary Anterior Cruciate Ligament Reconstruction

“…Also, drilling the femoral tunnel through an AM portal allows obtaining tunnel aperture which overlaps with the native ACL footprint, while drilling through the tibial tunnel hardly covers part of the AM footprint (Abebe et al, 2009). Modifying the tibial tunnel orientation to overcome this issue has been proposed (Chhabra et al, 2004;Heming et al, 2007;Kopf et al, 2010;Miller et al, 2010). When drilling a more horizontal tunnel, and starting more medial it becomes possible to target the native ACL footprint.…”