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Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study.
Arthroscopy. 2012 Oct; 28(10):1481-9.A

Abstract

PURPOSE

To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs.

METHODS

Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction.

RESULTS

In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P = .03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P > .05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P < .05).

CONCLUSION

Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability.

CLINICAL RELEVANCE

This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.

Authors+Show Affiliations

Scott and White Memorial Hospital, Temple, Texas 76508, USA. mdriscoll@swmail.sw.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22796141

Citation

Driscoll, Matthew D., et al. "Comparison of 2 Femoral Tunnel Locations in Anatomic Single-bundle Anterior Cruciate Ligament Reconstruction: a Biomechanical Study." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 28, no. 10, 2012, pp. 1481-9.
Driscoll MD, Isabell GP, Conditt MA, et al. Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy. 2012;28(10):1481-9.
Driscoll, M. D., Isabell, G. P., Conditt, M. A., Ismaily, S. K., Jupiter, D. C., Noble, P. C., & Lowe, W. R. (2012). Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 28(10), 1481-9. https://doi.org/10.1016/j.arthro.2012.03.019
Driscoll MD, et al. Comparison of 2 Femoral Tunnel Locations in Anatomic Single-bundle Anterior Cruciate Ligament Reconstruction: a Biomechanical Study. Arthroscopy. 2012;28(10):1481-9. PubMed PMID: 22796141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. AU - Driscoll,Matthew D, AU - Isabell,Gene P,Jr AU - Conditt,Michael A, AU - Ismaily,Sabir K, AU - Jupiter,Daniel C, AU - Noble,Philip C, AU - Lowe,Walter R, Y1 - 2012/07/15/ PY - 2011/06/10/received PY - 2012/03/13/revised PY - 2012/03/14/accepted PY - 2012/7/17/entrez PY - 2012/7/17/pubmed PY - 2012/12/25/medline SP - 1481 EP - 9 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 - 28 IS - 10 N2 - PURPOSE: To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. METHODS: Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. RESULTS: In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P = .03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P > .05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P < .05). CONCLUSION: Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. CLINICAL RELEVANCE: This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/22796141/Comparison_of_2_femoral_tunnel_locations_in_anatomic_single_bundle_anterior_cruciate_ligament_reconstruction:_a_biomechanical_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(12)00211-3 DB - PRIME DP - Unbound Medicine ER -