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Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging.
Arthroscopy. 2011 Nov; 27(11):1511-22.A

Abstract

PURPOSE

Using 3-dimensional high-resolution magnetic resonance imaging (MRI), we sought to compare femoral and tibial tunnel position and resultant graft obliquity with single-bundle anterior cruciate ligament (ACL) reconstruction using transtibial (TT) or anteromedial (AM) portal femoral tunnel reaming techniques.

METHODS

Thirty patients were prospectively enrolled after primary, autogenous bone-patellar tendon-bone ACL reconstruction by 2 groups of high-volume, fellowship-trained sports medicine surgeons. With the TT technique, an external starting point was used to maximize graft obliquity and femoral footprint capture. By use of high-resolution MRI and imaging analysis software, bilateral 3-dimensional knee models were created, mirrored, and superimposed. Differences between centroids for each femoral and tibial insertion, as well as corresponding ACL/graft obliquity, were evaluated with paired t tests and 2-sided Mann-Whitney nonparametric tests, with P < .05 defined as significant.

RESULTS

No significant differences were observed between groups in position of reconstructed femoral footprints. However, on the tibial side, AM centroids averaged 0.8 ± 1.9 mm anterior to native ACL centroids, whereas the TT group centered 5.23 ± 2.4 mm posterior to native ACL centroids (P < .001). Sagittal obliquity was closely restored with the AM technique (mean, 52.2° v. 53.5° for native ACL) but was significantly more vertical (mean, 66.9°) (P = .0001) for the TT group.

CONCLUSIONS

In this clinical series, AM portal femoral tunnel reaming more accurately restored native ACL anatomy than the TT technique. Although both techniques can capture the native femoral footprint with similar accuracy, the TT technique requires significantly greater posterior placement of the tibial tunnel, resulting in decreased sagittal graft obliquity. When a tibial tunnel is drilled without the need to accommodate subsequent femoral tunnel reaming, more accurate tibial tunnel position and resultant sagittal graft obliquity are achieved.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Authors+Show Affiliations

Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21963097

Citation

Bowers, Andrea L., et al. "Comparison of Anterior Cruciate Ligament Tunnel Position and Graft Obliquity With Transtibial and Anteromedial Portal Femoral Tunnel Reaming Techniques Using High-resolution Magnetic Resonance Imaging." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 27, no. 11, 2011, pp. 1511-22.
Bowers AL, Bedi A, Lipman JD, et al. Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy. 2011;27(11):1511-22.
Bowers, A. L., Bedi, A., Lipman, J. D., Potter, H. G., Rodeo, S. A., Pearle, A. D., Warren, R. F., & Altchek, D. W. (2011). Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 27(11), 1511-22. https://doi.org/10.1016/j.arthro.2011.07.007
Bowers AL, et al. Comparison of Anterior Cruciate Ligament Tunnel Position and Graft Obliquity With Transtibial and Anteromedial Portal Femoral Tunnel Reaming Techniques Using High-resolution Magnetic Resonance Imaging. Arthroscopy. 2011;27(11):1511-22. PubMed PMID: 21963097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. AU - Bowers,Andrea L, AU - Bedi,Asheesh, AU - Lipman,Joseph D, AU - Potter,Hollis G, AU - Rodeo,Scott A, AU - Pearle,Andrew D, AU - Warren,Russell F, AU - Altchek,David W, Y1 - 2011/10/01/ PY - 2011/03/21/received PY - 2011/07/05/revised PY - 2011/07/06/accepted PY - 2011/10/4/entrez PY - 2011/10/4/pubmed PY - 2012/6/7/medline SP - 1511 EP - 22 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 - 11 N2 - PURPOSE: Using 3-dimensional high-resolution magnetic resonance imaging (MRI), we sought to compare femoral and tibial tunnel position and resultant graft obliquity with single-bundle anterior cruciate ligament (ACL) reconstruction using transtibial (TT) or anteromedial (AM) portal femoral tunnel reaming techniques. METHODS: Thirty patients were prospectively enrolled after primary, autogenous bone-patellar tendon-bone ACL reconstruction by 2 groups of high-volume, fellowship-trained sports medicine surgeons. With the TT technique, an external starting point was used to maximize graft obliquity and femoral footprint capture. By use of high-resolution MRI and imaging analysis software, bilateral 3-dimensional knee models were created, mirrored, and superimposed. Differences between centroids for each femoral and tibial insertion, as well as corresponding ACL/graft obliquity, were evaluated with paired t tests and 2-sided Mann-Whitney nonparametric tests, with P < .05 defined as significant. RESULTS: No significant differences were observed between groups in position of reconstructed femoral footprints. However, on the tibial side, AM centroids averaged 0.8 ± 1.9 mm anterior to native ACL centroids, whereas the TT group centered 5.23 ± 2.4 mm posterior to native ACL centroids (P < .001). Sagittal obliquity was closely restored with the AM technique (mean, 52.2° v. 53.5° for native ACL) but was significantly more vertical (mean, 66.9°) (P = .0001) for the TT group. CONCLUSIONS: In this clinical series, AM portal femoral tunnel reaming more accurately restored native ACL anatomy than the TT technique. Although both techniques can capture the native femoral footprint with similar accuracy, the TT technique requires significantly greater posterior placement of the tibial tunnel, resulting in decreased sagittal graft obliquity. When a tibial tunnel is drilled without the need to accommodate subsequent femoral tunnel reaming, more accurate tibial tunnel position and resultant sagittal graft obliquity are achieved. LEVEL OF EVIDENCE: Level III, retrospective comparative study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/21963097/Comparison_of_anterior_cruciate_ligament_tunnel_position_and_graft_obliquity_with_transtibial_and_anteromedial_portal_femoral_tunnel_reaming_techniques_using_high_resolution_magnetic_resonance_imaging_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(11)00668-2 DB - PRIME DP - Unbound Medicine ER -