Skip to main content
Erschienen in: International Orthopaedics 9/2018

26.04.2018 | Original Paper

Location of the femoral tunnel aperture during single-bundle posterior cruciate ligament reconstruction: outside-in versus inside-out techniques

verfasst von: Jun-Ho Kim, Hoon-Young Kim, Dae-Hee Lee

Erschienen in: International Orthopaedics | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Placement of the femoral tunnel is critical to graft function after posterior cruciate ligament (PCL) reconstruction. To date, however, the location of the femoral tunnel aperture has not been compared by in vivo 3-dimensional computed tomography (3D-CT) during PCL reconstruction with the outside-in (OI) and inside-out (IO) techniques. This study used 3D-CT analysis to compare the location of the femoral tunnel aperture in patients who underwent PCL reconstruction with the OI and IO techniques.

Methods

A total of 77 patients underwent single-bundle PCL reconstruction using the OI (n = 46) or IO (n = 31) technique. The location of the femoral tunnel aperture was assessed by 3D-CT and measured by the anatomic coordinate axis method to construct 3D surface models.

Results

The mean location of the femoral tunnel aperture in the low-to-high direction did not differ significantly in the OI and IO groups (75.0 vs. 75.2%, P = 0.869). However, in the deep-to-shallow direction, the femoral tunnel aperture was positioned more shallowly in the IO than in the OI group (75.7 vs. 81.1%, P < 0.001).

Conclusion

The IO technique of single-bundle PCL reconstruction yielded a shallower femoral tunnel in the deep-to-shallow direction than did the OI technique. However, femoral tunnel location in the low-to-high direction was similar using the two techniques.
Literatur
1.
Zurück zum Zitat Markolf KL, Feeley BT, Jackson SR, McAllister DR (2006) Where should the femoral tunnel of a posterior cruciate ligament reconstruction be placed to best restore anteroposterior laxity and ligament forces? Am J Sports Med 34:604–611CrossRefPubMed Markolf KL, Feeley BT, Jackson SR, McAllister DR (2006) Where should the femoral tunnel of a posterior cruciate ligament reconstruction be placed to best restore anteroposterior laxity and ligament forces? Am J Sports Med 34:604–611CrossRefPubMed
2.
Zurück zum Zitat Shin YS, Han SB, Hwang YK, Suh DW, Lee DH (2015) Tibial tunnel aperture location during single-bundle posterior cruciate ligament reconstruction: comparison of tibial guide positions. Arthroscopy 31:874–881CrossRefPubMed Shin YS, Han SB, Hwang YK, Suh DW, Lee DH (2015) Tibial tunnel aperture location during single-bundle posterior cruciate ligament reconstruction: comparison of tibial guide positions. Arthroscopy 31:874–881CrossRefPubMed
3.
Zurück zum Zitat Apsingi S, Bull AM, Deehan DJ, Amis AA (2009) Review: femoral tunnel placement for PCL reconstruction in relation to the PCL fibre bundle attachments. Knee Surg Sports Traumatol Arthrosc 17:652–659CrossRefPubMed Apsingi S, Bull AM, Deehan DJ, Amis AA (2009) Review: femoral tunnel placement for PCL reconstruction in relation to the PCL fibre bundle attachments. Knee Surg Sports Traumatol Arthrosc 17:652–659CrossRefPubMed
4.
Zurück zum Zitat Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426CrossRefPubMed Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426CrossRefPubMed
5.
Zurück zum Zitat Shin YS, Ro KH, Lee JH, Lee DH (2013) Location of the femoral tunnel aperture in single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal, and outside-in techniques. Am J Sports Med 41:2533–2539CrossRefPubMed Shin YS, Ro KH, Lee JH, Lee DH (2013) Location of the femoral tunnel aperture in single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal, and outside-in techniques. Am J Sports Med 41:2533–2539CrossRefPubMed
6.
Zurück zum Zitat Seo SS, Seo JH, Kim DH, Park BY (2015) Compression of the popliteal artery after posterior cruciate ligament reconstruction using the tibial inlay technique. Knee Surg Relat Res 27:274–277CrossRefPubMedPubMedCentral Seo SS, Seo JH, Kim DH, Park BY (2015) Compression of the popliteal artery after posterior cruciate ligament reconstruction using the tibial inlay technique. Knee Surg Relat Res 27:274–277CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Lopes OV Jr, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH (2008) Topography of the femoral attachment of the posterior cruciate ligament. J Bone Joint Surg Am 90:249–255CrossRefPubMed Lopes OV Jr, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH (2008) Topography of the femoral attachment of the posterior cruciate ligament. J Bone Joint Surg Am 90:249–255CrossRefPubMed
8.
Zurück zum Zitat Bach BR, Daluga DJ, Mikosz R, Andriacchi TP, Seidl R (1992) Force displacement characteristics of the posterior cruciate ligament. Am J Sports Med 20:67–71 discussion 71-72CrossRefPubMed Bach BR, Daluga DJ, Mikosz R, Andriacchi TP, Seidl R (1992) Force displacement characteristics of the posterior cruciate ligament. Am J Sports Med 20:67–71 discussion 71-72CrossRefPubMed
9.
Zurück zum Zitat Grood ES, Hefzy MS, Lindenfield TN (1989) Factors affecting the region of most isometric femoral attachments. Part I: the posterior cruciate ligament. Am J Sports Med 17:197–207CrossRefPubMed Grood ES, Hefzy MS, Lindenfield TN (1989) Factors affecting the region of most isometric femoral attachments. Part I: the posterior cruciate ligament. Am J Sports Med 17:197–207CrossRefPubMed
10.
Zurück zum Zitat Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T (2006) Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 34:456–463CrossRefPubMed Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T (2006) Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 34:456–463CrossRefPubMed
11.
Zurück zum Zitat Jang KM, Park SC, Lee DH (2016) Graft bending angle at the intra-articular femoral tunnel aperture after single-bundle posterior cruciate ligament reconstruction: inside-out versus outside-in techniques. Am J Sports Med 44:1269–1275CrossRefPubMed Jang KM, Park SC, Lee DH (2016) Graft bending angle at the intra-articular femoral tunnel aperture after single-bundle posterior cruciate ligament reconstruction: inside-out versus outside-in techniques. Am J Sports Med 44:1269–1275CrossRefPubMed
12.
Zurück zum Zitat Lee DC, Shon OJ, Kwack BH, Lee SJ (2013) Proprioception and clinical results of anterolateral single-bundle posterior cruciate ligament reconstruction with remnant preservation. Knee Surg Relat Res 25:126–132CrossRefPubMedPubMedCentral Lee DC, Shon OJ, Kwack BH, Lee SJ (2013) Proprioception and clinical results of anterolateral single-bundle posterior cruciate ligament reconstruction with remnant preservation. Knee Surg Relat Res 25:126–132CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Tompkins M, Keller TC, Milewski MD, Gaskin CM, Brockmeier SF, Hart JM, Miller MD (2013) Anatomic femoral tunnels in posterior cruciate ligament reconstruction: inside-out versus outside-in drilling. Am J Sports Med 41:43–50CrossRefPubMed Tompkins M, Keller TC, Milewski MD, Gaskin CM, Brockmeier SF, Hart JM, Miller MD (2013) Anatomic femoral tunnels in posterior cruciate ligament reconstruction: inside-out versus outside-in drilling. Am J Sports Med 41:43–50CrossRefPubMed
15.
Zurück zum Zitat Chen CH, Chen WJ, Shih CH (2001) One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 17:329–332CrossRefPubMed Chen CH, Chen WJ, Shih CH (2001) One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 17:329–332CrossRefPubMed
16.
Zurück zum Zitat Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101CrossRefPubMed Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101CrossRefPubMed
17.
Zurück zum Zitat Lubowitz JH, Konicek J (2010) Anterior cruciate ligament femoral tunnel length: cadaveric analysis comparing anteromedial portal versus outside-in technique. Arthroscopy 26:1357–1362CrossRefPubMed Lubowitz JH, Konicek J (2010) Anterior cruciate ligament femoral tunnel length: cadaveric analysis comparing anteromedial portal versus outside-in technique. Arthroscopy 26:1357–1362CrossRefPubMed
18.
Zurück zum Zitat Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, Miller MD (2012) Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med 40:1313–1321CrossRefPubMed Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, Miller MD (2012) Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med 40:1313–1321CrossRefPubMed
19.
Zurück zum Zitat Cosgarea AJ, Jay PR (2001) Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg 9:297–307CrossRefPubMed Cosgarea AJ, Jay PR (2001) Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg 9:297–307CrossRefPubMed
20.
Zurück zum Zitat Chiang ER, Ma HL, Wang ST, Hung SC, Liu CL, Chen TH (2012) Hamstring graft sizes differ between Chinese and Caucasians. Knee Surg Sports Traumatol Arthrosc 20:916–921CrossRefPubMed Chiang ER, Ma HL, Wang ST, Hung SC, Liu CL, Chen TH (2012) Hamstring graft sizes differ between Chinese and Caucasians. Knee Surg Sports Traumatol Arthrosc 20:916–921CrossRefPubMed
21.
Zurück zum Zitat Kim JG, Chang MH, Lim HC, Bae JH, Ahn JH, Wang JH (2013) Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: do different anatomic reconstruction techniques create similar femoral tunnels? Am J Sports Med 41:2512–2520CrossRefPubMed Kim JG, Chang MH, Lim HC, Bae JH, Ahn JH, Wang JH (2013) Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: do different anatomic reconstruction techniques create similar femoral tunnels? Am J Sports Med 41:2512–2520CrossRefPubMed
22.
Zurück zum Zitat Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610CrossRefPubMed Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610CrossRefPubMed
23.
Zurück zum Zitat Race A, Amis AA (1998) PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 80:173–179CrossRefPubMed Race A, Amis AA (1998) PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 80:173–179CrossRefPubMed
24.
Zurück zum Zitat Mannor DA, Shearn JT, Grood ES, Noyes FR, Levy MS (2000) Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension. Am J Sports Med 28:833–845CrossRefPubMed Mannor DA, Shearn JT, Grood ES, Noyes FR, Levy MS (2000) Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension. Am J Sports Med 28:833–845CrossRefPubMed
25.
Zurück zum Zitat Lee DY, Park YJ (2017) Single-bundle versus double-bundle posterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials. Knee Surg Relat Res 29:246–255CrossRefPubMedPubMedCentral Lee DY, Park YJ (2017) Single-bundle versus double-bundle posterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials. Knee Surg Relat Res 29:246–255CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Burns WC 2nd, Draganich LF, Pyevich M, Reider B (1995) The effect of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. Am J Sports Med 23:424–430CrossRefPubMed Burns WC 2nd, Draganich LF, Pyevich M, Reider B (1995) The effect of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. Am J Sports Med 23:424–430CrossRefPubMed
27.
Zurück zum Zitat Galloway MT, Grood ES, Mehalik JN, Levy M, Saddler SC, Noyes FR (1996) Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement. Am J Sports Med 24:437–445CrossRefPubMed Galloway MT, Grood ES, Mehalik JN, Levy M, Saddler SC, Noyes FR (1996) Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement. Am J Sports Med 24:437–445CrossRefPubMed
28.
Zurück zum Zitat Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF (2012) Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Joint Surg Am 94:1936–1945CrossRefPubMed Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF (2012) Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Joint Surg Am 94:1936–1945CrossRefPubMed
29.
Zurück zum Zitat Race A, Amis AA (1994) The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 27:13–24CrossRefPubMed Race A, Amis AA (1994) The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 27:13–24CrossRefPubMed
Metadaten
Titel
Location of the femoral tunnel aperture during single-bundle posterior cruciate ligament reconstruction: outside-in versus inside-out techniques
verfasst von
Jun-Ho Kim
Hoon-Young Kim
Dae-Hee Lee
Publikationsdatum
26.04.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 9/2018
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-018-3954-3

Weitere Artikel der Ausgabe 9/2018

International Orthopaedics 9/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.