Abstract
BackgroundIn the anatomic double-bundle ACL reconstruction, 2 femoral tunnel positions are particularly critical to obtain better clinical results. Recently, a few studies have reported quantitative identification methods for posterolateral (PL) bundle reconstruction. Concerning anteromedial (AM) bundle reconstruction, however, no quantitative clinically available methods to insert a guide wire at the center of the direct attachment of the AM mid-substance fibers have been reported to date.MethodsFirst, we determined the center of the femoral attachment of the AM mid-substance fibers using 38 fresh frozen cadaveric knees. Based on this anatomical sub-study, we developed a quantitative clinical technique to insert a guide wire at the averaged center for anatomic double-bundle ACL reconstruction. In the second clinical sub-study with 63 patients who underwent anatomic ACL reconstruction with this quantitative technique, we determined the center of an actually created AM tunnel. Then, we compared the results of the second sub-study with those of the first sub-study to validate the accuracy of the quantitative technique. In both the sub-studies, we determined the center of the anatomical attachment and the tunnel outlet using the “3-dimensional clock” system. The tunnel outlet was evaluated using the “transparent” 3-dimensional computed tomography.ResultsThe averaged center of the direct attachment of the AM bundle midsubstance fibers was located on the cylindrical surface of the femoral intercondylar notch at “10:37” (or “1:23”) o’clock orientation in the distal view and at 5.0-mm from the proximal outlet of the intercondylar notch (POIN) in the lateral view. The AM tunnel actually created in ACL reconstruction was located at “10:41” (or “1:19”) o’clock orientation in the average and at 5.0-mm from the POIN. There was no significant difference between the 2 center locations.ConclusionsThe quantitative technique enabled us to easily create the femoral AM tunnel at the averaged center of the direct attachment of the AM bundle midsubstance fibers with high accuracy. This study reported information on the geometric location of the femoral attachment of the AM bundle and a clinically useful technique for its anatomical reconstruction.
Highlights
In the anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, 2 femoral tunnel positions are critical to obtain better clinical results
Keeping the hook at this point, we rotated the offset guide so that the tip of a guide wire inserted through the guide was aimed at the “1:30” or “10:30” o’clock orientation in the arthroscopic visual field (Figure 4)
The most important finding of the present study was that this first anatomical sub-study clarified where the averaged center of the direct attachment of the AM bundle midsubstance fibers was located on the cylindrical surface of the femoral intercondylar notch around its proximal outlet
Summary
In the anatomic double-bundle ACL reconstruction, 2 femoral tunnel positions are critical to obtain better clinical results. Biomechanical studies have shown advantages of anatomic double-bundle ACL reconstruction, in which 2 femoral tunnels were created at the center of the direct attachment of the AM and PL mid-substance fibers, respectively [11,12,13,14,15]. Concerning AM bundle reconstruction, no quantitative clinically available methods to insert a guidewire at the center of the direct attachment of the AM mid-substance fibers have been reported to date. At this point in time, surgeons have to subjectively determine the insertion point of a guidewire in an arthroscopic visual field to anatomically reconstruct the AM bundle This fact may result in the wide variation of the location of the femoral tunnel created for AM bundle reconstruction reported in the literature [8,15,28,34,35]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
