Abstract
BackgroundThis paper reports an in-vitro study for evaluating the influence of the femoral tunnel orientation in anterior cruciate ligament (ACL) double-bundle reconstructions.MethodsThis work describes the experimental protocol and results obtained for six cadaver knees using the FlashPoint optical system (Image Guided, Boulder, Colorado, USA) and a computer-assisted technique for the elaboration of anatomical and kinematic data. Each specimen was examined by the same surgeon in the following steps: (1) intact knee stability was evaluated by performing antero-posterior displacement and internal-external rotation test at 90°; (2) the ACL was resected and the knee evaluated again; (3) the ACL was reconstructed using the gracilis semi-tendinous tendon (through horizontal tunnels in femur), and the new kinematics recorded; (4) the ACL was reconstructed again with the same tendon, but with a more vertical orientation of the femoral tunnel (vertical tunnel) and kinematics was once more recorded; (5) finally the knee was dissected to digitise the anatomical structures.ResultsOff-line computer analysis of the acquired anatomical and kinematic data showed that there was a significant statistical difference (Wilcoxon test with the Montecarlo method for small samples – p = 0.035) between horizontal tunnel (HT) and vertical tunnel (VT) reconstruction both in the antero-posterior test (median antero-posterior displacement in horizontal tunnel was 0.8 mm less than in vertical tunnel reconstruction) and in the internal-external (IE) rotation test (median internal-external rotation in horizontal tunnel reconstruction was 5° less than in vertical tunnel reconstruction).ConclusionThe analysis of graft behavior in reconstructed knees compared with normal and ACL-deficient knees suggests that the most horizontal tunnel performed better than the vertical tunnel, thus constraining optimally both antero-posterior and internal-external rotations. This finding suggests that femoral tunnel direction may be an important issue in ACL surgery.
Highlights
This paper reports an in-vitro study for evaluating the influence of the femoral tunnel orientation in anterior cruciate ligament (ACL) double-bundle reconstructions
Zantop [4] has recently shown that the kinematics expecially for the anterior tibial translation in low flexion angles under Lachman test and simulated pivot shift test can be contributed to the integrity of the PL bundle
The global effect of the two reconstructions was estimated by performing the Wilcoxon test with the Montecarlo method for small samples, applied between ACL-deficient knees and horizontal tunnel reconstructions and between ACL-deficient knees and vertical tunnel reconstructions, respectively
Summary
This paper reports an in-vitro study for evaluating the influence of the femoral tunnel orientation in anterior cruciate ligament (ACL) double-bundle reconstructions. For example Yagi [5] recently investigated the biomechanical effect of anatomic double bundle reconstruction with autologous implants with respect to single bundles, while Guardamagna [6] evaluated in a cadaver study the effect of AM and PL bundles reconstructed with synthetic implants. These studies underlined that double bundle reconstructions more closely reproduce the functional behavior of the normal ACL. All theses recent studies underline the importance of femoral tunnel orientation for better performances of ACL reconstruction This topic has not been completely addressed in double bundle reconstruction
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