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Comparison of anatomic versus nonanatomic placement of femoral tunnels in Achilles double-bundle posterior cruciate ligament reconstruction.
Arthroscopy. 2010 May; 26(5):658-66.A

Abstract

PURPOSE

In this study, we compared femoral tunnel pairs that differ by group in a double-bundle Achilles tendon allograft posterior cruciate ligament (PCL) reconstruction.

METHODS

Group 1 patients had femoral tunnels drilled nearly within the footprint area most proximal and most distal to the axis of the femur. Group 2 patients had femoral tunnels drilled eccentrically within the footprint along an axis nearly perpendicular to the axis of the femur. Patient assessments were made subjectively with preoperative and postoperative assessments of Lysholm rating scale, posterior drawer test, and dial test. Objective assessments used range of motion and quadriceps circumference. Group 1 contained 7 patients with a mean age of 32 years (range, 20 to 46 years). Group 2 contained 10 patients with a mean age of 32 years (range, 20 to 46 years).

RESULTS

Group 2 patients had significantly less posterior laxity than group 1 patients. Postoperatively, 6 patients in group 1 (86%) had a positive posterior drawer test compared with 3 in group 2 (30%). Rotational laxity was identified by dial test results postoperatively in 3 patients in group 1 (43%) compared with 0% in group 2. Extension deficit occurred in 2 patients in group 1 (29%) and 1 patient in group 2 (10%). Flexion deficit occurred more than twice as frequently in group 1 (71% [5 patients]) than in group 2 (30% [3 patients]). There were no statistically significant differences for other comparisons.

CONCLUSIONS

The clinical outcomes support the group 2 method with femoral tunnel placement at the anterior-most and posterior-most portions of the femoral PCL insertion. The group 2 procedure described in this study incorporates advanced principles for successful outcomes with Achilles double-bundle PCL reconstruction.

LEVEL OF EVIDENCE

Level III, case-control study.

Authors+Show Affiliations

mcguired@alaska.netNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20434664

Citation

McGuire, David A., and Stephen D. Hendricks. "Comparison of Anatomic Versus Nonanatomic Placement of Femoral Tunnels in Achilles Double-bundle Posterior Cruciate Ligament Reconstruction." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 26, no. 5, 2010, pp. 658-66.
McGuire DA, Hendricks SD. Comparison of anatomic versus nonanatomic placement of femoral tunnels in Achilles double-bundle posterior cruciate ligament reconstruction. Arthroscopy. 2010;26(5):658-66.
McGuire, D. A., & Hendricks, S. D. (2010). Comparison of anatomic versus nonanatomic placement of femoral tunnels in Achilles double-bundle posterior cruciate ligament reconstruction. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 26(5), 658-66. https://doi.org/10.1016/j.arthro.2009.09.008
McGuire DA, Hendricks SD. Comparison of Anatomic Versus Nonanatomic Placement of Femoral Tunnels in Achilles Double-bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy. 2010;26(5):658-66. PubMed PMID: 20434664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of anatomic versus nonanatomic placement of femoral tunnels in Achilles double-bundle posterior cruciate ligament reconstruction. AU - McGuire,David A, AU - Hendricks,Stephen D, Y1 - 2010/03/03/ PY - 2008/11/25/received PY - 2009/09/02/revised PY - 2009/09/08/accepted PY - 2010/5/4/entrez PY - 2010/5/4/pubmed PY - 2010/9/4/medline SP - 658 EP - 66 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 26 IS - 5 N2 - PURPOSE: In this study, we compared femoral tunnel pairs that differ by group in a double-bundle Achilles tendon allograft posterior cruciate ligament (PCL) reconstruction. METHODS: Group 1 patients had femoral tunnels drilled nearly within the footprint area most proximal and most distal to the axis of the femur. Group 2 patients had femoral tunnels drilled eccentrically within the footprint along an axis nearly perpendicular to the axis of the femur. Patient assessments were made subjectively with preoperative and postoperative assessments of Lysholm rating scale, posterior drawer test, and dial test. Objective assessments used range of motion and quadriceps circumference. Group 1 contained 7 patients with a mean age of 32 years (range, 20 to 46 years). Group 2 contained 10 patients with a mean age of 32 years (range, 20 to 46 years). RESULTS: Group 2 patients had significantly less posterior laxity than group 1 patients. Postoperatively, 6 patients in group 1 (86%) had a positive posterior drawer test compared with 3 in group 2 (30%). Rotational laxity was identified by dial test results postoperatively in 3 patients in group 1 (43%) compared with 0% in group 2. Extension deficit occurred in 2 patients in group 1 (29%) and 1 patient in group 2 (10%). Flexion deficit occurred more than twice as frequently in group 1 (71% [5 patients]) than in group 2 (30% [3 patients]). There were no statistically significant differences for other comparisons. CONCLUSIONS: The clinical outcomes support the group 2 method with femoral tunnel placement at the anterior-most and posterior-most portions of the femoral PCL insertion. The group 2 procedure described in this study incorporates advanced principles for successful outcomes with Achilles double-bundle PCL reconstruction. LEVEL OF EVIDENCE: Level III, case-control study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/20434664/Comparison_of_anatomic_versus_nonanatomic_placement_of_femoral_tunnels_in_Achilles_double_bundle_posterior_cruciate_ligament_reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(09)00793-2 DB - PRIME DP - Unbound Medicine ER -