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Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction.
Am J Sports Med. 2015 Sep; 43(9):2250-8.AJ

Abstract

BACKGROUND

Anatomic graft tunnel placement is recommended in anterior cruciate ligament (ACL) reconstruction to restore knee joint stability and function. Transtibial (TT), anteromedial portal (AMP), and outside-in (OI) retrograde drilling surgical techniques have been described for tibial and femoral bone tunnel preparation.

PURPOSE/HYPOTHESIS

The purpose of this study was to evaluate the bone tunnel parameters and compare the ability of 3 different surgical techniques to achieve placement of the ACL femoral and tibial bone tunnels at the center of the native ACL femoral and tibial attachment sites. The hypothesis was that tunnel placement using an AMP or OI technique would result in optimized tunnel parameters and more closely reconstruct the center of the native ACL femoral attachment site.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

The study population consisted of 100 patients undergoing anatomic single-bundle ACL reconstruction using multiple-stranded hamstring tendon grafts. In group 1 (n = 36), the femoral tunnel was drilled using a TT surgical technique; in group 2 (n = 32), the femoral tunnel was drilled through an AMP; and in group 3 (n = 32), the femoral tunnel was created by use of an OI technique with retrograde drilling. Computed tomography (CT) scans were obtained postoperatively, and characteristics of femoral and tibial tunnel apertures were correlated to femoral and tibial measurement grid systems. The position of the resulting tibial and femoral bone tunnels for each group was compared with the center of the native ACL attachment sites.

RESULTS

There were statistically significant differences (P < .05) for the ACL femoral tunnel between the 3 groups with respect to intercondylar height, total tunnel length, graft fixation length, tunnel axis, and tunnel entry angle. Statistically significant differences (P < .05) were found for the ACL tibial tunnel with respect to anteroposterior tunnel position and sagittal tunnel axis between the TT and both the OI and AMP techniques. The OI surgical technique produced more oblique and anatomically correct femoral tunnel apertures and longer femoral tunnel lengths compared with the AMP technique. Both AMP and OI techniques resulted in a more precise replication of intercondylar tunnel depth and height. There was no statistically significant difference for graft fixation length between the AMP and OI techniques.

CONCLUSION

The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques.

Authors+Show Affiliations

Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria michael.osti@lkhf.at.Department for Diagnostic and Interventional Radiology, Academic Hospital Feldkirch, Feldkirch, Austria.Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria.Department for Trauma Surgery and Sports Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria.Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria.

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

26138734

Citation

Osti, Michael, et al. "Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-in Single-bundle Anterior Cruciate Ligament Reconstruction." The American Journal of Sports Medicine, vol. 43, no. 9, 2015, pp. 2250-8.
Osti M, Krawinkel A, Ostermann M, et al. Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(9):2250-8.
Osti, M., Krawinkel, A., Ostermann, M., Hoffelner, T., & Benedetto, K. P. (2015). Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 43(9), 2250-8. https://doi.org/10.1177/0363546515590221
Osti M, et al. Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-in Single-bundle Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2015;43(9):2250-8. PubMed PMID: 26138734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction. AU - Osti,Michael, AU - Krawinkel,Alessa, AU - Ostermann,Michael, AU - Hoffelner,Thomas, AU - Benedetto,Karl Peter, Y1 - 2015/07/02/ PY - 2015/7/4/entrez PY - 2015/7/4/pubmed PY - 2016/4/5/medline KW - ACL reconstruction, transtibial technique KW - anatomy KW - anteromedial portal technique KW - computed tomography KW - outside-in technique SP - 2250 EP - 8 JF - The American journal of sports medicine JO - Am J Sports Med VL - 43 IS - 9 N2 - BACKGROUND: Anatomic graft tunnel placement is recommended in anterior cruciate ligament (ACL) reconstruction to restore knee joint stability and function. Transtibial (TT), anteromedial portal (AMP), and outside-in (OI) retrograde drilling surgical techniques have been described for tibial and femoral bone tunnel preparation. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the bone tunnel parameters and compare the ability of 3 different surgical techniques to achieve placement of the ACL femoral and tibial bone tunnels at the center of the native ACL femoral and tibial attachment sites. The hypothesis was that tunnel placement using an AMP or OI technique would result in optimized tunnel parameters and more closely reconstruct the center of the native ACL femoral attachment site. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study population consisted of 100 patients undergoing anatomic single-bundle ACL reconstruction using multiple-stranded hamstring tendon grafts. In group 1 (n = 36), the femoral tunnel was drilled using a TT surgical technique; in group 2 (n = 32), the femoral tunnel was drilled through an AMP; and in group 3 (n = 32), the femoral tunnel was created by use of an OI technique with retrograde drilling. Computed tomography (CT) scans were obtained postoperatively, and characteristics of femoral and tibial tunnel apertures were correlated to femoral and tibial measurement grid systems. The position of the resulting tibial and femoral bone tunnels for each group was compared with the center of the native ACL attachment sites. RESULTS: There were statistically significant differences (P < .05) for the ACL femoral tunnel between the 3 groups with respect to intercondylar height, total tunnel length, graft fixation length, tunnel axis, and tunnel entry angle. Statistically significant differences (P < .05) were found for the ACL tibial tunnel with respect to anteroposterior tunnel position and sagittal tunnel axis between the TT and both the OI and AMP techniques. The OI surgical technique produced more oblique and anatomically correct femoral tunnel apertures and longer femoral tunnel lengths compared with the AMP technique. Both AMP and OI techniques resulted in a more precise replication of intercondylar tunnel depth and height. There was no statistically significant difference for graft fixation length between the AMP and OI techniques. CONCLUSION: The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/26138734/Femoral_and_tibial_graft_tunnel_parameters_after_transtibial_anteromedial_portal_and_outside_in_single_bundle_anterior_cruciate_ligament_reconstruction_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546515590221?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -