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Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques.
Arthroscopy. 2011 Dec; 27(12):1663-70.A

Abstract

PURPOSE

The purpose of this study was to use magnetic resonance (MR) imaging to evaluate the translational and rotational kinematics of anterior cruciate ligament (ACL) reconstructed knees with transtibial (TT) and anteromedial (AM) femoral tunnel drilling.

METHODS

ACL reconstruction was performed in 21 subjects: 12 with AM drilling (5 men and 7 women; mean age, 33 ± 9 years; imaged 18 ± 5 months after surgery) and 9 with TT drilling (5 men and 4 women; mean age, 32 ± 9 years; imaged 12 ± 8 months after surgery). Three-tesla MR imaging was obtained bilaterally at extension and 30° to 40° of flexion under simulated loading (125 N). MR images were segmented and kinematic calculations done with in-house MATLAB software (The MathWorks, Natick, MA). Translation and rotation of the tibia and the tibiofemoral contact area were measured. Statistical analysis treated reconstructed and contralateral knees as independent groups. Reconstructed groups were compared with analysis of covariance using contralateral knees as baseline. P < .05 indicated significance.

RESULTS

All kinematic measures in the AM group were similar to contralateral knees. The TT group showed significantly more total tibial rotation than contralateral knees (TT, 8.4° ± 3.9°; contralateral, 2.9° ± 6.8°) (P = .03), whereas the AM group did not (AM, 3.1° ± 5.6°; contralateral, 2.3° ± 5.4°) (P = .36). At knee extension, the tibia was more externally rotated in the TT group than in controls. Medial tibial translation was greater in the TT group than in controls. The AM group showed increased contact area in the lateral compartment compared with controls; no differences were seen in the TT group.

CONCLUSIONS

Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Authors+Show Affiliations

School of Medicine, University of California, San Francisco, 94143-0728, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21958672

Citation

Schairer, William W., et al. "Magnetic Resonance Imaging Evaluation of Knee Kinematics After Anterior Cruciate Ligament Reconstruction With Anteromedial and Transtibial Femoral Tunnel Drilling Techniques." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 27, no. 12, 2011, pp. 1663-70.
Schairer WW, Haughom BD, Morse LJ, et al. Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques. Arthroscopy. 2011;27(12):1663-70.
Schairer, W. W., Haughom, B. D., Morse, L. J., Li, X., & Ma, C. B. (2011). Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 27(12), 1663-70. https://doi.org/10.1016/j.arthro.2011.06.032
Schairer WW, et al. Magnetic Resonance Imaging Evaluation of Knee Kinematics After Anterior Cruciate Ligament Reconstruction With Anteromedial and Transtibial Femoral Tunnel Drilling Techniques. Arthroscopy. 2011;27(12):1663-70. PubMed PMID: 21958672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques. AU - Schairer,William W, AU - Haughom,Bryan D, AU - Morse,Lee Jae, AU - Li,Xiaojuan, AU - Ma,C Benjamin, Y1 - 2011/09/29/ PY - 2011/01/19/received PY - 2011/05/20/revised PY - 2011/06/24/accepted PY - 2011/10/1/entrez PY - 2011/10/1/pubmed PY - 2012/6/8/medline SP - 1663 EP - 70 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 - 27 IS - 12 N2 - PURPOSE: The purpose of this study was to use magnetic resonance (MR) imaging to evaluate the translational and rotational kinematics of anterior cruciate ligament (ACL) reconstructed knees with transtibial (TT) and anteromedial (AM) femoral tunnel drilling. METHODS: ACL reconstruction was performed in 21 subjects: 12 with AM drilling (5 men and 7 women; mean age, 33 ± 9 years; imaged 18 ± 5 months after surgery) and 9 with TT drilling (5 men and 4 women; mean age, 32 ± 9 years; imaged 12 ± 8 months after surgery). Three-tesla MR imaging was obtained bilaterally at extension and 30° to 40° of flexion under simulated loading (125 N). MR images were segmented and kinematic calculations done with in-house MATLAB software (The MathWorks, Natick, MA). Translation and rotation of the tibia and the tibiofemoral contact area were measured. Statistical analysis treated reconstructed and contralateral knees as independent groups. Reconstructed groups were compared with analysis of covariance using contralateral knees as baseline. P < .05 indicated significance. RESULTS: All kinematic measures in the AM group were similar to contralateral knees. The TT group showed significantly more total tibial rotation than contralateral knees (TT, 8.4° ± 3.9°; contralateral, 2.9° ± 6.8°) (P = .03), whereas the AM group did not (AM, 3.1° ± 5.6°; contralateral, 2.3° ± 5.4°) (P = .36). At knee extension, the tibia was more externally rotated in the TT group than in controls. Medial tibial translation was greater in the TT group than in controls. The AM group showed increased contact area in the lateral compartment compared with controls; no differences were seen in the TT group. CONCLUSIONS: Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear. LEVEL OF EVIDENCE: Level III, retrospective comparative study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/21958672/Magnetic_resonance_imaging_evaluation_of_knee_kinematics_after_anterior_cruciate_ligament_reconstruction_with_anteromedial_and_transtibial_femoral_tunnel_drilling_techniques_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(11)00621-9 DB - PRIME DP - Unbound Medicine ER -