Abstract
PurposeThe effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG).Materials and MethodsNinety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge.ResultsThe TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm.ConclusionsThis study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.
Highlights
Optimal tunnel placement and graft alignment are important factors associated with successful outcomes of anterior cruciate ligament (ACL) reconstruction[1,2])
The risk of tibial intra-articular aperture expansion caused by iatrogenic re-reaming of the tibial tunnel has been reported as a major disadvantage of the transtibial technique3,8), which may lead to a graft-tunnel mismatch and a delay in incorporation of the graft9)
The purpose of this study was to investigate the severity of intra-articular aperture widening and proportion of knees with a tibial tunnel length (TTL) less than 35 mm at different angles of the tibial guide (TG) in ACL reconstruction using the modified transtibial technique
Summary
Optimal tunnel placement and graft alignment are important factors associated with successful outcomes of anterior cruciate ligament (ACL) reconstruction[1,2]). Improper alignment and placement of a graft within tunnels created by the transtibial technique may result in graft impingement, graft-tunnel mismatch or tibial aperture widening[3,4,5,6,7]). The risk of tibial intra-articular aperture expansion caused by iatrogenic re-reaming of the tibial tunnel has been reported as a major disadvantage of the transtibial technique3,8), which may lead to a graft-tunnel mismatch and a delay in incorporation of the graft[9]). The direction of the guidewire determined as the optimal trajectory toward the anatomical femoral footprint may cause iatrogenic re-reaming of the tibial tunnel and www.jksrr.org
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