Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleInfluence of Knee Flexion Angle on Femoral Tunnel Characteristics When Drilled Through the Anteromedial Portal During Anterior Cruciate Ligament Reconstruction
Section snippets
Methods
Eight fresh cadaveric specimens were used. The full lower limbs were deep-frozen and thawed at room temperature 48 hours before the experiment. Specimen inclusion criteria were no previous surgery around the knee, intact ACL and posterior cruciate ligaments, no notch stenosis, and no osteoarthritis greater than International Cartilage Repair Society grade 3. The upper extremity of the femur was clamped in a vice. Using a long metal ruler, the longitudinal axis of the thigh, defined as the line
Results
With regard to tunnel orientation, there was a trend toward less vertical tunnels with each increase in knee flexion angle on the AP view (P = .0633). The mean angles, plus or minus the 95% confidence limit with reference to the bicondylar line, started from an average of 54.7° for the 90° guidewire and progressed to an average of 40.3° for a guidewire inserted with maximum flexion (Table 1). The greatest difference occurs between the 90° and the hyperflexion groups, with a mean difference of
Discussion
Few papers have discussed the use of the AM portal versus transtibial techniques6, 7, 8, 9, 10, 11 for drilling the femoral tunnel in single-bundle ACL reconstruction. These papers have shown that the anatomic attachment site of the ACL can easily be reached through the AM portal. Many papers have stressed the importance of using an anatomic positioning instead of an isometric one to restore a normal knee kinematics.1, 2, 4, 5, 12, 13, 14, 15, 16 Recently, Chhabra et al.17 have shown when using
Conclusions
In accordance to our hypothesis, the results of this study show the knee flexion angle influences the position of the femoral drilling, however, hyperflexion is not the optimal knee flexion angle when drilling the femoral tunnel through the AM portal. It appears in the current study that 110° is optimum, while 90° pin leads to short tunnel and is so close to the posterior wall there are high risks of posterior wall blow out when drilling the tunnel at its final diameter. Also, 130° knee flexion
Acknowledgment
The authors thank the Laboratory of Anatomy of Tours University Medical School, France, and the Imaging Department of The Hospital Paul d’Egine, Champigny sur Marne, France.
References (22)
- et al.
Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement
Arthroscopy
(2003) - et al.
Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: Operative technique and preliminary results
Arthroscopy
(1999) - et al.
Femoral tunnel position in anterior cruciate ligament reconstruction using three techniquesA cadaver study
Arthroscopy
(1999) - et al.
Single-bundle anterior cruciate ligament reconstruction using the medial portal technique
Oper Tech Orthop
(2005) - et al.
Tunnel expansion after anterior cruciate ligament reconstruction with autogeneous hamstrings: A comparison of the medial portal and transtibial techniques
Arthroscopy
(2006) - et al.
Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction
Arthroscopy
(2006) - et al.
Anatomical reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon graftsAnatomical and clinical studies
Arthroscopy
(2004) - et al.
A description of the anterior cruciate ligament attachments for anatomical reconstruction: A cadaveric study
Arthroscopy
(2006) - et al.
Anterior cruciate ligament graft positioning, tensioning and twisting
Knee Surg Sports Traumatol Arthrosc
(1998) - et al.
Varying femoral tunnels between the anatomical footprint and isometric positions: Effect on kinematics of the anterior cruciate ligament-reconstructed knee
Am J Sports Med
(2005)
Knee stability and graft function after anterior cruciate ligament reconstruction: A comparison of a lateral and an anatomical femoral tunnel placement
Am J Sports Med
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Supported in part by a research grant from Smith & Nephew, Le Mans, France.