The “Footprint” Anterior Cruciate Ligament Technique: An Anatomic Approach to Anterior Cruciate Ligament Reconstruction

Bedi, Asheesh; Altchek, David W.

doi:10.1016/j.arthro.2009.03.008

Cited by 133 publications

(115 citation statements)

References 46 publications

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“…30 More importantly the orientation of the graft, which has been associated with in vivo joint function following ACL reconstruction, 17,18 is strongly influenced by the location of the ACL footprint on both the tibia and femur. Therefore, given the variations between subjects in the healthy population, anatomic graft placement should be performed and evaluated on an individual basis, guided by the patient-specific locations of the ACL footprint 24 rather than by conventional normative population reference values.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23] Taken together, these findings have generated interest in surgical recommendations, both transtibial and independent femoral tunnel placement techniques, that emphasize placement of the graft in the center of the native ligament footprints. [24][25][26][27][28][29] Given that significant anatomic variation exists between patients, 30 there is a clear need to understand the interaction between ACL footprint position and orientation for the evaluation of anatomic graft placement on a patient-specific basis as more surgeons begin to adopt anatomic ''footprint'' techniques.…”

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confidence: 99%

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Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

Scanlan

Lai

Donahue³

et al. 2011

Journal Orthopaedic Research

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Recent reports have indicated that anatomical placement of the anterior cruciate ligament (ACL) graft is an important factor for restoration of joint function following ACL reconstruction. The objective of this study was to address a need for a better understanding of anatomical variations in ACL position and orientation within the joint. Specifically, variations in the ACL anatomy were assessed by testing for side-to-side ACL footprint location symmetry in a healthy population relative to the operative and contralateral knee in a patient population after traditional transtibial single-bundle ACL reconstruction. MRI and three-dimensional modeling techniques were used to determine the in vivo tibiofemoral ACL footprint centers and the resulting ACL orientations in both knees of 30 healthy subjects and 30 subjects after transtibial ACL reconstruction. While there were substantial inter-subject variations in ACL anatomy, the side-to-side RMS differences in the ACL footprint center were 1.20 and 1.34 mm for the femur and tibia, respectively, for the healthy subjects and no clinically meaningful intra-subject differences were measured. However, there were large intrasubject side-to-side differences after transtibial ACL reconstruction, with ACL grafts placed 5.63 and 7.64 mm from the center of the contralateral femoral and tibial ACL footprint centers, respectively. Grafts were placed more medial, anterior, and superior on the femur and more posterior on the tibia; producing grafts that were more vertical in the sagittal and coronal planes. Given the large variation among subjects, these findings advocate the use of the contralateral ACL morphology for retrospectively evaluating patientspecific anatomic graft placement. ß

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

Scanlan

Lai

Donahue³

et al. 2011

Journal Orthopaedic Research

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“…Bedi and Altchek have modified antero-medial portal drilling with the use of a flexible guidewire and reaming system performing anatomic ACL reconstruction in over 100 "footprint" reconstructions with minimal intraoperative or postoperative complications [83].…”

Section: Anatomical Single Bundle Techniquesmentioning

confidence: 99%

Anatomical single bundle anterior cruciate ligament reconstruction

Carmont

Scheffler

Spalding

et al. 2011

Curr Rev Musculoskelet Med

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“…The high learning curve, long duration of surgery, difficulty of revision, high rate of complications, and development of instability caused by tunnel expansion reduce the usability of the double-bundle method (9)(10)(11)(12)(13). Although the single-bundle method is currently more preferable, when applying this method, the anatomical placement of the graft affects the success of the procedure (13)(14)(15)(16)(17)(18). No consensus has been reached on the issues of graft preference, the number of bundles, or the techniques to be used when opening the tunnel.…”

Section: Introductionmentioning

confidence: 99%

Results of an Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction by the Anteromedial Method

Çetinkaya¹,

Mutlu²,

Yavuz³

et al. 2016

JAREM

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Objective: This study aimed to evaluate the results of patients undergoing single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) with the anteromedial portal technique and the effects of surgical timing on the results.Methods: A total of 47 patients (44 males, three females; mean age: 27 years) were included in this study. Lachman test, pivot shift test and KT-2000 arthrometry, International Knee Documentation Committee (IKDC) and Lysholm activity scoring were used in the preoperative and final follow-up in order to clinically evaluate. Furthermore, 17 patients undergoing early surgery (within the first 6 months) and 30 patients undergoing late surgery were compared for the presence of additional pathologies and functional results. Results:The mean follow-up period was 25 months (range: 13-36 months). Lachman test, Pivot-shift test, KT-2000, Lysholm, and IKDC scores significantly improved during the final follow-up according to the preoperative values. Eighty-two percent (14/17) of patients in the early surgery group (ten medial, three lateral, and one bilateral) and 96% (29/30) of patients in the late surgery group (seventeen medial, five lateral, and seven bilateral) had meniscus tear, and the difference was statistically significant. Four patients requiring microfracture were present in the late surgery group. Functional outcome was better in patients in the early surgery group, although the difference was statistically not significant. Conclusion:Anatomical reconstruction of ACL with the anteromedial portal technique is an effective method to improve clinical and functional results. Additionally, early surgery will improve functional results because it will decrease the frequency of additional pathology. (JAREM 2016; 6: 88-93)

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The “Footprint” Anterior Cruciate Ligament Technique: An Anatomic Approach to Anterior Cruciate Ligament Reconstruction

Cited by 133 publications

References 46 publications

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

Anatomical single bundle anterior cruciate ligament reconstruction

Results of an Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction by the Anteromedial Method

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