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Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling.
Am J Sports Med. 2012 Jun; 40(6):1313-21.AJ

Abstract

BACKGROUND

During anatomic anterior cruciate ligament (ACL) reconstruction, we have found that the femoral footprint can best be visualized from the anteromedial portal. Independent femoral tunnel drilling can then be performed through an accessory medial portal, medial and inferior to the standard anteromedial portal.

PURPOSE

To compare the accuracy of independent femoral tunnel placement relative to the ACL footprint using an accessory medial portal versus tunnel placement with a traditional transtibial technique.

STUDY DESIGN

Controlled laboratory study.

METHODS

Ten matched pairs of cadaveric knees were randomized such that within each pair, one knee underwent arthroscopic transtibial (TT) drilling, and the other underwent drilling through an accessory medial portal (AM). All knees underwent computed tomography (CT) both preoperatively and postoperatively with a technique optimized for ligament evaluation (80 keV with maximum mAs). Computed tomography was performed with a dual-energy scanner. Commercially available third-party software was used to fuse the preoperative and postoperative CT scans, allowing anatomic comparison of the ACL footprint to the drilled tunnel. The ACL footprint was marked in consensus by an orthopaedic surgeon and a musculoskeletal radiologist and then compared with the tunnel aperture after drilling. The percentage of tunnel aperture contained within the native footprint as well as the distance from the center of the tunnel aperture to the center of the footprint was measured.

RESULTS

The AM technique placed 97.7% ± 5% of the tunnel within the native femoral footprint, significantly more than 61.2% ± 24% for the TT technique (P = .001). The AM technique placed the center of the femoral tunnel 3.6 ± 1.2 mm from the center of the native footprint, significantly closer than 6.0 ± 1.9 mm for the TT technique (P = .003).

CONCLUSION

This study demonstrates that use of an accessory medial portal will facilitate more accurate placement of the femoral tunnel in the native ACL femoral footprint.

CLINICAL RELEVANCE

More accurate placement of the femoral tunnel in the native ACL femoral footprint should improve the ability to achieve more anatomic positioning of the ACL graft.

Authors+Show Affiliations

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. tompkinsm@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22523370

Citation

Tompkins, Marc, et al. "Anatomic Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: Use of an Accessory Medial Portal Versus Traditional Transtibial Drilling." The American Journal of Sports Medicine, vol. 40, no. 6, 2012, pp. 1313-21.
Tompkins M, Milewski MD, Brockmeier SF, et al. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med. 2012;40(6):1313-21.
Tompkins, M., Milewski, M. D., Brockmeier, S. F., Gaskin, C. M., Hart, J. M., & Miller, M. D. (2012). Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. The American Journal of Sports Medicine, 40(6), 1313-21. https://doi.org/10.1177/0363546512443047
Tompkins M, et al. Anatomic Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: Use of an Accessory Medial Portal Versus Traditional Transtibial Drilling. Am J Sports Med. 2012;40(6):1313-21. PubMed PMID: 22523370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. AU - Tompkins,Marc, AU - Milewski,Matthew D, AU - Brockmeier,Stephen F, AU - Gaskin,Cree M, AU - Hart,Joseph M, AU - Miller,Mark D, Y1 - 2012/04/20/ PY - 2012/4/24/entrez PY - 2012/4/24/pubmed PY - 2012/10/16/medline SP - 1313 EP - 21 JF - The American journal of sports medicine JO - Am J Sports Med VL - 40 IS - 6 N2 - BACKGROUND: During anatomic anterior cruciate ligament (ACL) reconstruction, we have found that the femoral footprint can best be visualized from the anteromedial portal. Independent femoral tunnel drilling can then be performed through an accessory medial portal, medial and inferior to the standard anteromedial portal. PURPOSE: To compare the accuracy of independent femoral tunnel placement relative to the ACL footprint using an accessory medial portal versus tunnel placement with a traditional transtibial technique. STUDY DESIGN: Controlled laboratory study. METHODS: Ten matched pairs of cadaveric knees were randomized such that within each pair, one knee underwent arthroscopic transtibial (TT) drilling, and the other underwent drilling through an accessory medial portal (AM). All knees underwent computed tomography (CT) both preoperatively and postoperatively with a technique optimized for ligament evaluation (80 keV with maximum mAs). Computed tomography was performed with a dual-energy scanner. Commercially available third-party software was used to fuse the preoperative and postoperative CT scans, allowing anatomic comparison of the ACL footprint to the drilled tunnel. The ACL footprint was marked in consensus by an orthopaedic surgeon and a musculoskeletal radiologist and then compared with the tunnel aperture after drilling. The percentage of tunnel aperture contained within the native footprint as well as the distance from the center of the tunnel aperture to the center of the footprint was measured. RESULTS: The AM technique placed 97.7% ± 5% of the tunnel within the native femoral footprint, significantly more than 61.2% ± 24% for the TT technique (P = .001). The AM technique placed the center of the femoral tunnel 3.6 ± 1.2 mm from the center of the native footprint, significantly closer than 6.0 ± 1.9 mm for the TT technique (P = .003). CONCLUSION: This study demonstrates that use of an accessory medial portal will facilitate more accurate placement of the femoral tunnel in the native ACL femoral footprint. CLINICAL RELEVANCE: More accurate placement of the femoral tunnel in the native ACL femoral footprint should improve the ability to achieve more anatomic positioning of the ACL graft. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/22523370/Anatomic_femoral_tunnel_drilling_in_anterior_cruciate_ligament_reconstruction:_use_of_an_accessory_medial_portal_versus_traditional_transtibial_drilling_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546512443047?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -