Tags

Type your tag names separated by a space and hit enter

Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: a clinical and imaging analysis.
Int Orthop. 2012 Apr; 36(4):845-52.IO

Abstract

PURPOSE

It has been reported that technical error in positioning the graft tunnel is the most common problem in anterior cruciate ligament (ACL) reconstruction. The objective of this study was to quantitatively evaluate femoral and tibial tunnel positions and intra-articular graft orientation of primary ACL reconstruction in patients who had undergone revision ACL reconstruction. We postulated that this patient cohort had a nonanatomically positioned tunnel and graft orientation.

METHODS

Twenty-six patients who had undergone a revision ACL were investigated. Clinical magnetic resonance (MR) images prior to revision were analysed. Three-dimensional models of bones and tunnels on the femur and tibia were created. Intra-articular graft orientation was measured in axial, sagittal and coronal planes. Graft positions were measured on the tibial plateau as a percentage from anterior to posterior and medial to lateral; graft positions on the femur were measured using the quadrant method.

RESULTS

Sagittal elevation angle for failed ACL reconstruction graft (69.6° ± 13.4°) was significantly greater (p < 0.05) than that of the native anteromedial (AM) and posterolateral (PL) bundles of the ACL (AM 56.2° ± 6.1°, PL 55.5° ± 8.1°). In the transverse plane, the deviation angle of the failed graft (37.3° ± 21.0°) was significantly greater than native ACL bundles. The tibial tunnel in this patient cohort was placed posteromedially and medially to the anatomical AM and PL bundles, respectively. The femoral tunnel was placed anteriorly to the anatomical AM and PL bundles.

CONCLUSIONS

This study reveals that both the tibial and femoral tunnel positions and consequently the intra-articular graft orientation in this patient group with failed ACL reconstruction were nonanatomical when compared with native ACL values. The results can be used to improve tunnel placement in ACL reconstruction.

Authors+Show Affiliations

Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21826407

Citation

Hosseini, Ali, et al. "Tunnel Position and Graft Orientation in Failed Anterior Cruciate Ligament Reconstruction: a Clinical and Imaging Analysis." International Orthopaedics, vol. 36, no. 4, 2012, pp. 845-52.
Hosseini A, Lodhia P, Van de Velde SK, et al. Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: a clinical and imaging analysis. Int Orthop. 2012;36(4):845-52.
Hosseini, A., Lodhia, P., Van de Velde, S. K., Asnis, P. D., Zarins, B., Gill, T. J., & Li, G. (2012). Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: a clinical and imaging analysis. International Orthopaedics, 36(4), 845-52. https://doi.org/10.1007/s00264-011-1333-4
Hosseini A, et al. Tunnel Position and Graft Orientation in Failed Anterior Cruciate Ligament Reconstruction: a Clinical and Imaging Analysis. Int Orthop. 2012;36(4):845-52. PubMed PMID: 21826407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: a clinical and imaging analysis. AU - Hosseini,Ali, AU - Lodhia,Parth, AU - Van de Velde,Samuel K, AU - Asnis,Peter D, AU - Zarins,Bertram, AU - Gill,Thomas J, AU - Li,Guoan, Y1 - 2011/08/09/ PY - 2011/07/05/received PY - 2011/07/21/accepted PY - 2011/8/10/entrez PY - 2011/8/10/pubmed PY - 2012/7/20/medline SP - 845 EP - 52 JF - International orthopaedics JO - Int Orthop VL - 36 IS - 4 N2 - PURPOSE: It has been reported that technical error in positioning the graft tunnel is the most common problem in anterior cruciate ligament (ACL) reconstruction. The objective of this study was to quantitatively evaluate femoral and tibial tunnel positions and intra-articular graft orientation of primary ACL reconstruction in patients who had undergone revision ACL reconstruction. We postulated that this patient cohort had a nonanatomically positioned tunnel and graft orientation. METHODS: Twenty-six patients who had undergone a revision ACL were investigated. Clinical magnetic resonance (MR) images prior to revision were analysed. Three-dimensional models of bones and tunnels on the femur and tibia were created. Intra-articular graft orientation was measured in axial, sagittal and coronal planes. Graft positions were measured on the tibial plateau as a percentage from anterior to posterior and medial to lateral; graft positions on the femur were measured using the quadrant method. RESULTS: Sagittal elevation angle for failed ACL reconstruction graft (69.6° ± 13.4°) was significantly greater (p < 0.05) than that of the native anteromedial (AM) and posterolateral (PL) bundles of the ACL (AM 56.2° ± 6.1°, PL 55.5° ± 8.1°). In the transverse plane, the deviation angle of the failed graft (37.3° ± 21.0°) was significantly greater than native ACL bundles. The tibial tunnel in this patient cohort was placed posteromedially and medially to the anatomical AM and PL bundles, respectively. The femoral tunnel was placed anteriorly to the anatomical AM and PL bundles. CONCLUSIONS: This study reveals that both the tibial and femoral tunnel positions and consequently the intra-articular graft orientation in this patient group with failed ACL reconstruction were nonanatomical when compared with native ACL values. The results can be used to improve tunnel placement in ACL reconstruction. SN - 1432-5195 UR - https://www.unboundmedicine.com/medline/citation/21826407/Tunnel_position_and_graft_orientation_in_failed_anterior_cruciate_ligament_reconstruction:_a_clinical_and_imaging_analysis_ L2 - https://dx.doi.org/10.1007/s00264-011-1333-4 DB - PRIME DP - Unbound Medicine ER -