DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20164627

Assessment of foot print of femoral tunnel placement with commercially available off set guide in arthroscopic ACL reconstruction

Vinay Tantuway, S. A. Mustafa Johar, Viral Patel, Ashok Nagla, Rishi Gupta, Pawan Bhambani

Abstract


Background: Accurate placement of the femoral tunnel is critical for long-term clinical success following anterior cruciate ligament (ACL) reconstruction.  Current trends in ACL reconstruction favor anatomic positioning of ACL attachment sites. Surgical inaccuracy in femoral tunnel positioning can lead to potential early graft failure and early-onset osteoarthritis. The purpose of this study was to evaluate the functional outcome in patients who underwent arthroscopic anatomic ACL reconstruction using hamstring tendon graft.

Methods: The study was conducted in the Orthopedics Department of IIMCHRC, Indore the placement of femoral tunnel, using femoral off set guide with other techniques. All the patients who were diagnosed clinically and radiologically with ACL tear and all who gave the consent were included in the study. All patients were enrolled to undergo primary arthroscopically assisted ACL reconstruction.

Results: In the present study out of 42 patients; 23 patients (55%) had right sided ACL injury and remaining 19 patients (45%) had left sided ACL injury. We assessed functional outcome of the patients through pre-operative and post-operative IKDC scoring. The mean of the pre-op IKDC scoring was 33.61 with SD of 9.67 and the mean of the post-operative IKDC scoring was 77.95 with SD of 15.15.

Conclusions: The commercially available off set guide technique of the femoral tunnel placement in arthroscopic ACL reconstruction is easy, reliable and reproducible with the foot print at anatomical place on the femoral site.


Keywords


Anterior cruciate ligament (ACL), Femoral tunnel, Arthroscopy, ACL reconstruction

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References


Moore KL. The Knee Joint. In: Clinically oriented anatomy. 2n ed. Williams & Wilkins 1985: 523-541.

Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, et al. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy. 2006;22:984-92.

Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral at tachment of the anterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(11):1218-25.

Purnell ML, Larson AI, Clancy W. Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med. 2008;36:2083-90.

Siebold R, Ellert T, Metz S, Metz J. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy. 2008;24:154-61.

Siebold R, Ellert T, Metz S, Metz J. Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy. 2008;24:585-92.

Takahashi M, Doi M, Abe M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med. 2006;34:787-92.

Bernard M, Hertel P, Hornung H, Cierpinski TH. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10:14-22.

Terry Canale S, Beaty JH. Campbell's Operative Orthopaedics. Volume 4. 13th Edition. Amsterdam: Elsevier; 2016: 2424.

Jepsen CF, Lundberg-Jensen AK, Faunoe P. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy. 2007;23:1326-33.

Pinczewski LA, Salmon LJ, Jackson WF, von Bormann RB, Haslam PG, Tashiro S. Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2008;90:172-9.

Kato Y, Ingham JM, Kramer S, Smolinski P, Saito P, Fu F. Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthros. 2010;18(1):2-10.

Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N. Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 2010;38(1):25-34.

Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB. The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med. 1996;24(3):335-41.

Hoshino Y, Nagamune K, Yagi M, Araki D, Nishimoto K, Kubo S, et al. The effect of intra-operative knee flexion angle on determination of graft location in the anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2009;17(9):1052-60.

Harner CD, Honkamp NJ, Ranawat AS. Anteromedialportal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24(1):113-5.

Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci. 2008;13(2):122-9.

Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10:14-22.

Arnold JA, Coker TP, Heaton LM, Park JP, Harris WD. Natural history of anterior cruciate tears. Am J Sports Med. 1979;7:305–13.

Fetto JF, Marshall JL. The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop. 1980;147:29–38.

Andersson C, Gillquist J. Treatment of acute isolated and combined ruptures of ACL-A long term follow up study. Am J Sports. 1992;20(1):7-12.

Tenuta JJ, Arciero RA. Arthroscopic evaluation of meniscal repairs. Factors that affect healing. Am J Sports Med. 1994;22(6):797-802.

Aparajit P, Koichade MR, Nimesh Jain N. Study of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injury. Int J Biomed Res. 2016;7(6):329-36.

Rand J, Steiner ME, Heming JF. Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2007;35(10):1708-15.

Bernard M, Hertel P. Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty. A radiologic measuring method (quadrant method). Unfallchirurg. 1996;99(5):332-40.

Abraham VT, Krishnagopal R, Kondreddi V, Mahapatra S. A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score. Int J Res Orthop. 2016;2:346-9.

Chen CH, Chang CH, Su CL, Wang KC, Liu HT, Yu CM, et al. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: Clinical outcome at 2 to 7 years. Arthroscopy. 2010;26(7):907-17.

Irrgang JJ, Ho H, Harner CD, Fu FH. Use of the international knee documentation committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee surg sports Traumatol Arthrosc. 1998;6(2):107-14.

Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K. Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft: An 8 year follow up of a randomized controlled trial. Am J Sports Med. 2010;38(8):1533-41.

Shervegar S, Nagaraj P, Grover A, DJ NG, Ravoof A. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study. Arch Bone Joint Surg. 2015;3(4):264-8.