Iatrogenic injury of the anterior meniscal root attachments following anterior cruciate ligament reconstruction tunnel reaming

Abstract

To determine whether reaming of anterior cruciate ligament (ACL) reconstruction tibial tunnels with a 10-mm-diameter reamer would result in injury to the anterior roots of the medial and lateral menisci in an in vitro model when using a tibial aiming device at two settings (40° and 60°). Three-dimensional footprints of the ACL and the anterior roots of the menisci were measured for 12 human cadaveric tibias. Measurements were taken before and after attempted reaming of an ACL tibial reconstruction tunnel in the calculated ACL centre using a tibial aiming device set at two angles (40° and 60°). Iatrogenic injury to the anterior root of the medial meniscus caused by overlap with the reamed tibial tunnel was found in 3/6 specimens in Group 1 (40°) and 0/6 specimens in Group 2 (60°). The average area of iatrogenic injury in Group 1 was 9.6mm(2) (8.6% of the root). There was iatrogenic injury to the anterior root of the lateral meniscus in 4/6 specimens for both groups. The average area of iatrogenic injury was 20.5mm(2) (28.8%) for Group 1 and 16.2mm(2) (25.9%) for Group 2. Reaming of ACL tibial reconstruction tunnels carries a risk of iatrogenic injury to the anterior meniscus roots, even when tunnels are reamed based on guide pin placement in the calculated centre of the ACL. Reaming at varying tibial aiming device angle settings can affect the obliquity of the tunnel aperture and cause iatrogenic injury to the anterior meniscal roots. Caution should be exercised clinically to avoid iatrogenic injury to both the anterior meniscal roots while reaming tibial tunnels during ACL reconstructions.