Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleComparison Between Rigid and Flexible Systems for Drilling the Femoral Tunnel Through an Anteromedial Portal in Anterior Cruciate Ligament Reconstruction
Section snippets
Methods
Ten ethylene glycol–preserved cadaveric knee specimens were obtained from the Department of Anatomy. Each specimen was kept at room temperature throughout the study. There were 9 female specimens and 1 male specimen. The mean age of the specimens was 82 years (range, 67 to 97 years). There were 5 left and 5 right knees. Each specimen was mounted to simulate the standard arthroscopic position of 90° of knee flexion. A 30° arthroscope was placed by use of a trans–patellar tendon portal at the
Results
The data are summarized in Fig 2. The femoral interosseous distance of the flexible guide pins was longer than that of the straight guide pins (P = .01). This was because of the more proximal exit point on the lateral femoral cortex for the flexible guide pins (Fig 3). The mean interosseous distance was 37.1 mm (range, 34 to 42 mm) and 43.5 mm (range, 35 to 52 mm) for the straight and flexible guide pins, respectively. This difference was significant (P = .01). For the straight pin, 8 of 10
Discussion
This study examined the differences in ACL femoral tunnel drilling with a straight guide pin compared with a flexible guide pin drilled through a medial portal. The interosseous length of the tunnels drilled with the flexible guide pin were on average more than 6 mm longer than those drilled with a rigid straight pin. This allows for longer femoral sockets and is indicative of a more proximally directed femoral socket to allow a suspensory fixation device to be secured to the thicker lateral
Conclusions
The use of commercially available flexible reamers and 42° femoral guides results in longer femoral interosseous tunnel length than can be achieved with a straight guide pin. Femoral interosseous length consistently of 40 mm can be achieved with this technique and cannot be replicated with a rigid straight pin. This is advantageous for femoral tunnel drilling in an anatomic ACL reconstruction that uses suspensory fixation devices. There is minimal risk to the peroneal nerve and the femoral
Acknowledgment
The authors thank Margaret H. Cooper, Ph.D., Gregory S. Smith, Ph.D., and the staff of the Saint Louis University Center for Anatomical Science and Education for the use of their practical anatomy laboratory and their resources. They also thank Heidi A. Israel, Ph.D., for her help with the statistical analysis.
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2019, Journal of Orthopaedic ScienceCitation Excerpt :The major results of the cadaveric studies have revealed the superiority of tunnel creation reproducibility in TP and OI over TT [18–23]. An adequate tunnel length is important for graft healing to the bone in the tunnel [24] and for strong tendon pullout strength [25]. A few studies have reported the femoral tunnel length difference, and these have shown TT tunnel has longer tunnel length among these three approaches [16,18,26].
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2017, Arthroscopy - Journal of Arthroscopic and Related SurgeryOptimization of Anteromedial Portal Femoral Tunnel Drilling With Flexible and Straight Reamers in Anterior Cruciate Ligament Reconstruction: A Cadaveric 3-Dimensional Computed Tomography Analysis
2017, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Our study confirms that increasing knee flexion significantly increases the distance to the posterior cortex with maximum flexion allowing for the greatest distance. In the same respect, Silver et al.12 analyzed flexible and straight guide pins drilled through the AMP in knees flexed to 120° to demonstrate longer interosseous lengths using flexible pins. Although our study did not assess tunnel length at 120°, the virtual design allowed measurements throughout a range of knee flexion angles, verifying the longer tunnel provided by flexible systems.
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The authors report no conflict of interest.