Variability of tunnel positioning in ACL reconstruction

Shafizadeh, Sven; Balke, Maurice; Hagn, Ulrich; Hoeher, Juergen; Banerjee, Marc

doi:10.1007/s00402-014-2039-z

Cited by 10 publications

(6 citation statements)

References 37 publications

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“…There has been a recent increase of cadaveric studies that have identified radiographic landmarks of anatomic structures in various other orthopaedic surgical procedures, such as medial patellofemoral ligament, ACL, or LCL reconstructions, because the use of fluoroscopy has been shown to reduce the variability of tunnel positions. 12,17,19 Therefore, radiographic landmarks in LET procedures may similarly be useful in reducing the risk of tunnel misplacements, as well as in creating consistent results.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures

et al. 2019

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Background: Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. Purpose: To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. Study Design: Descriptive laboratory study. Methods: Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. Results: The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at –12% and 11% (anterior-posterior) and –17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. Conclusion: Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. Clinical Relevance: These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.

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Section: Discussionmentioning

confidence: 99%

Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures

et al. 2019

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“…Shafizadeh [131] in a cadaveric set‐up analysed the variability of tunnel positioning. Thirteen experienced surgeons were asked to identify arthroscopically both the femoral and the tibial tunnels for two times.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have showed that CAS may improve the accuracy of anatomical tunnel orientation and position during ACL reconstructive surgery [15,29,38,51,57,82,92,103,109,111,139,143,144]. Shafizadeh [131] in a cadaveric set-up analysed the variability of tunnel positioning. Thirteen experienced surgeons were asked to identify arthroscopically both the femoral and the tibial tunnels for two times.…”

Section: Navigation and Tunnel Placementmentioning

confidence: 99%

Current use of navigation system in ACL surgery: a historical review

Zaffagnini

Urrizola

Signorelli

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Causes for revision include, but are not limited to, nonanatomic tunnel placement, inadequate notchplasty, improper tensioning, insufficient graft material, arthrofibrosis, skeletal malalignment, varus/valgus instability, surgical techniques, and the type of graft utilized [8,9]. Compared to the primary reconstruction, revision surgeries are more complex as the existing femoral and tibial tunnels complicate the creation of new tunnels [10,11]. Furthermore, the recommended graft type varies with each procedure; moreover, surgeons have to choose between a single-stage or a two-stage revision [12].…”

Section: Introductionmentioning

confidence: 99%

The Multivariate Relationship Between Primary Anterior Cruciate Ligament Reconstruction Timing and Revision Rates: A 10-Year Analysis

Brown¹,

Hurlburt²,

Koenig³

et al. 2022

Cureus

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Background and objectiveThe optimal timing of anterior crucial ligament reconstruction (ACLR) remains a matter of controversy. A revision procedure is performed to improve knee function, correct instability, and enable a safe return to daily function when primary ACLR fails. The present study aimed to determine if the timing of primary ACLR is predictive of revision surgery. MethodsAll patients who underwent primary ACLR at the West Virginia University from January 2008 to December 2018 were identified. Patients were initially grouped into early (≤30 days) and late (>30 days) ACLR based on the onset of the initial injury. The major outcome measure of this study was the incidence of revision ACLR following primary ACLR. ResultsA total of 233 primary ACLRs were included. The incidence of ACLR revisions was 9.4%. The timing of primary ACLR, when categorized into early and late ACLRs, was not found to influence revision risk (p=0.384). Additionally, the damaged anatomical structures based on the postoperative diagnosis at the time of ACLR did not influence the odds of revision ACLR (p=0.9721). ConclusionOur study found that the timing of primary ACLR did not influence the revision rates when categorizing primary surgery time into early and late subgroups.

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Variability of tunnel positioning in ACL reconstruction

Cited by 10 publications

References 37 publications

Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures

Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures

Current use of navigation system in ACL surgery: a historical review

The Multivariate Relationship Between Primary Anterior Cruciate Ligament Reconstruction Timing and Revision Rates: A 10-Year Analysis

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