Abstract
BackgroundCommercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide.MethodsA total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed.ResultsIn the AM tunnel, tunnel axis angles in the coronal (β = 0.0252, p = 0.022) and sagittal (β = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (β = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700).ConclusionDrilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.
Highlights
Available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle
Of the 83 patients, 43 were excluded because they (1) had undergone anterior cruciate ligament (ACL) reconstruction using a rigid guide because there was no flexible reamer size option for either AM or PL grafts less than 6 mm in diameter (n = 19), (2) had undergone ACL reconstruction using another technique (n = 15), (3) had any combined multiple-ligament injury (n = 2), or (4) they had undergone a single bundle reconstruction for open physis (n = 2) and simultaneous reconstruction of the ACL and PCL (n = 4) combined with High tibial osteotomy (HTO) (n = 1)
Univariate regression analyses identified that the patient factors related to longer femoral tunnel length include male gender (β = 0.5212, p = 0.001), age (β = 0.0145, p = 0.023), Fig. 3 Angle in each plane projected from a three-dimensional surface model. a The angle between the tunnel and a line tangent to distal aspects in the coronal plane was measured. b The angle between the tunnel and a line tangent to the posterior aspects of the femoral condyles was measured in the axial plane. c The angle between the tunnel and the extended intersectional line of the femoral shaft in the sagittal plane was measured
Summary
Available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. Anterior cruciate ligament (ACL) surgical techniques with a primary focus on anatomic reconstruction have been considered to restore normal knee anatomy, kinematics, and stability more thoroughly [1,2,3]. This is provided by placing tunnels in the center of native ACL insertion sites on the tibia and femur using either the single- or double-bundle technique [4]. We became interested in the interosseous tunnel orientation in three dimensional planes, the extension of the intraarticular tunnel orientation
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