Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

<jats:title>Abstract</jats:title><jats:p>The purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Using postoperative 3D-CT, accurate axial views of the tibia plateau were evaluated. By assuming the medial and anterior borders of the tibia plateau as 0% and the lateral and posterior borders as 100%, the location of the medial and lateral tibial spine, and the center of the tibial tunnel were calculated. Statistical analysis was performed to assess the correlation between tibial spine location and tibial tunnel placement. The medial tibial spine was located at 54.7 ± 4.5% from the anterior border and 41.3 ± 3% from the medial border. The lateral tibial spine was located at 58.7 ± 5.1% from the anterior border and 55.3 ± 2.8% from the medial border. The ACL tibial tunnel was located at 34.8 ± 7.7% from the anterior border and 48.2 ± 3.4% from the medial border. Mediolateral tunnel placement was significantly correlated with medial and lateral tibial spine location. However, for anteroposterior tunnel placement, no significant correlation was found. A significant correlation was observed between mediolateral ACL tibial tunnel placement and medial and lateral tibial spine location. For clinical relevance, tibial ACL tunnel placement might be unintentionally influenced by tibial spine location. Confirmation of the ACL footprint is required to create accurate anatomical tunnels during surgery. This is a Level III; case–control study.</jats:p>

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

“…2 A previous study investigated the correlation between the location of the tibial spine and the ACL footprint morphology with the TSP technique, and the results indicated that the location of the tibial spine was likely to influence tibial tunnel placement. 5 Both techniques positioned the tibial tunnel medially in comparison to the anatomic site. Therefore, considering the requirement for an anatomically correct position, the surgeon should adjust the guide pin slightly more laterally when utilizing either of these positioning techniques.…”

“…In the present study, it was found that the location of the MLTS did not differ between the 2 groups, suggesting that the MLTS is a reliable anatomic landmark for tibial tunnel placement, with little variation between patients (Table 3). Iriuchishima and Goto 5 argued that the MLTS could unintentionally affect the judgment of surgeons in determining the tibial tunnel position and might result in tunnel misplacement. In contrast, our study showed that the tibial spine had no influence on the accuracy and precision of tibial tunnel positioning in the TSP group.…”

“…The accuracy (the mean distance of each actual location from the AC) and precision (the standard deviation of the accuracy, indicating the reproducibility of the tunnel position) of tibial tunnel positioning were calculated by applying the percentage grid system and using the Pythagorean theorem ( C = √ [ A 2 + B 2 ] in Figure 2). This method was in reference to Iriuchishima and Goto’s 5 research and has been proven to be reliable and valid in previous studies. 10,11…”

“…Arthroscopic knee surgery with the TSP technique, in which the torn ACL is resected, provides complete visibility of the tibial spine. 5 A previous study has shown that the location of the medial and lateral tibial spine (MLTS) can affect the judgment of surgeons in determining tibial tunnel placement when applying the transportal technique in anatomic single-bundle ACL reconstruction, which may lead to tunnel misplacement. 5 However, Dimitriou et al 2 reported that both the ARLM and medial tibial spine might be reliable landmarks for an anatomic tunnel, especially in cases of revision in which the ACL stump on the tibial side is not available.…”