Dependence of the outcomes of anterior cruciate ligament reconstruction on the tunnel positioning

Abstract


Purpose of study: based on the analysis of clinical and radiation data to determine the most favorable positioning of the bone tunnels at different techniques of anterior cruciate ligament (ACL) reconstruction. Study design: retrospective analysis. Patients and methods. Face-to-face and a remote examination was performed in 202 patients at terms from 1.5 to 5 years after primary ACL autoplasty using the graft from the popliteal muscle tendons. All patients were divided into 3 groups depending on the technique of the bone tunnels formation. The patients from the 1st group (n=109) were operated on using transtibial technique, from the 2nd (n=52) and 3rd (n=41) groups - using anteromedial technique with the positioning of the femoral tunnel in the central and anteromedial part of ACL attachment, respectively. Bone tunnels positioning was determined using CT with 3D reconstruction. Subjective evaluation was performed by IKDS-2000, KOOS and Lysholm knee score. To assess the tibiofemoral dislocation the anterior drawer, Lachman and pivot shift tests as well as arthrometry (comparison with the healthy side) were performed. Results. In patients from group 1 the tibial tunnel was positioned in the plane of either central or posterolateral part of ACL attachment. In groups 2 and 3 the tunnel was positioned closer to the anteromedial part. In the majority of patients form group 1 the femoral tunnel was positioned in the zone or slightly forwards of the anteromedial part of ACL femoral attachment, in group 2 - in the plane of central or posterolateral part, in group 3 - in the anteromedial part. In patients from the 1st and 2nd groups the subjective evaluation by IKDS-2000, KOOS and Lysholm knee score was comparable and much higher in the 3rd group (p<0.05). Objective evaluation showed positive manual tests results in 47 patients (62%) from the 1st group, 19 patients (51%) - 2nd group and 4 patients (11%) - 3rd group. Arthrometry showed the increase of anteroposterior tibiofemoral dislocation by 3.4±2.6 mm in the 1st group, 3.1±2.7 mm in the 2nd group and 1.2±1.4 mm. Statistical analysis did not reveal significant difference in knee stability between the patients from the 1st and 2nd groups. Conclusion. Positioning of the femoral tunnel in the plane of anteromedial part of ACL attachment ensures better surgical treatment functional results. In anteromedial technique the use of posterosuperior contour of the lateral femoral condyle as a reference point enables to improve the accuracy of femoral tunnel positioning as well as to minimize the error risk at intraoperative marking.

Full Text

Restricted Access

About the authors

Sergei A Bantser

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: sergeibantser@gmail.com
St. Petersburg, Russia
postgraduate, RSRI of TO n.a after R.R. Vreden

R. M Tikhilov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

A. P Trachuk

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

O. E Bogopol’skiy

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

A. V Rybin

Сity Hospital of St. George

St. Petersburg, Russia

D. A Shulepov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

M. R Salikhov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

References

  1. Kim S., Bosque J., Meehan J.P. et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J. Bone Joint Surg. Am. 2011; 93 (11): 994-1000. doi: 10.2106/JBJS.I.01618.
  2. Altertorn-Geli E., Lajara F., Samitier G., Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 2010; 18 (8): 1013-37. doi: 10.1007/s00167-009-0964-0.
  3. Gabler C.M., Jacobs C.A., Howard J.S. et al. Comparison of graft failure rate between autografts placed via an anatomic anterior cruciate ligament reconstruction technique: a systematic review, meta-analysis, and meta-regression. Am. J. Sports Med. 2016; 44 (4): 1069-79. doi: 10.1177/0363546515584043.
  4. Хоминец В.В., Рикун О.В., Шаповалов В.М. и др. Ревизионные реконструкции передней крестообразной связки при переднелатеральной ротационной нестабильности коленного сустава у военнослужащих. Военно-медицинский журнал. 2016; (6): 24-9.
  5. Martins C.A.Q., Kropf E.J., Shen W. et al. The concept of anatomic anterior cruciate ligament reconstruction. Oper. Tech. Sports Med. 2008; 16 (3): 104-15. doi: 10.1053/j.otsm.2008.10.008.
  6. Muller B., Duerr E.R.H., van Dijk C.N., Fu F.H. Anatomic anterior cruciate ligament reconstruction reducing anterior tibial subluxation. Knee Surg. Sports Traumatol. Arthrosc. 2016; 24 (9): 3005-10. doi: 10.1007/s00167-015-3612-x.
  7. Chechik O., Amar E., Khashan M. et al. An international survey on anterior cruciate ligament reconstruction practices. Int. Orthop. 2013; 37 (2): 201-7. doi: 10.1007/s00264-012-1611-9.
  8. Robin B.N., Jani S.S., Marvil S.C. et al. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. 2015; 31(7): 1412-9. doi: 10.1016/j.arthro.2015.01.018.
  9. Gadikota H.R., Sim J.A., Hosseini A. et al. The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am. J. Sports Med. 2012; 40 (4): 882-8. doi: 10.1177/0363546511434276.
  10. Kopf S., Forsythe B., Wong A.K. et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J. Bone Joint Surg. Am. 2010; 92 (6): 1427-31. doi: 10.2106/JBJS.I.00655.
  11. Janssen R.P.A., du Me´e A.V.F., van Valkenburg J. et al. Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol. Arthrosc. 2013; 21 (9): 1977-88. doi: 10.1007/s00167-012-2234-9.
  12. Lee M.C., Seong S.C., Lee S. et al. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy. 2007; 23 (7): 771-8.
  13. Kondo E., Merican A.M., Yasuda K., Amis A.A. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am. J. Sports Med. 2011; 39 (2): 279-88. doi: 10.1177/0363546510392350.
  14. Wang H., Fleischli J.E., Zheng N. Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction: outcomes of knee joint kinematics during walking. Am. J. Sports Med. 2013; 41 (8): 1847-56. doi: 10.1177/0363546513490663.
  15. Bohn M.B., Sorensen H., Petersen M.K. et al. Rotational laxity after anatomical ACL reconstruction measured by 3D-motion analysis: a prospective randomized trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg. Sports Traumatol. Arthrosc. 2015; 23 (12): 3473-81. doi: 10.1007/s00167-014-3156-5.
  16. Shea K.G., Carey J.L., Richmond J. et al. Management of anterior cruciate ligament injuries. J. Bone Joint Surg. Am. 2015; 97 (8): 672-6. doi: 10.2106/JBJS.N.01257.
  17. Rahr-Wagner L., Thillemann T.M., Pedersen A.B., Lind M.C. Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish knee ligament reconstruction register. Arthroscopy. 2013; 29 (1): 98-105. doi: 10.1016/j.arthro.2012.09.009.
  18. Pearle A.D., McAllister D., Howell S.M. Rationale for strategic graft placement in anterior cruciate ligament reconstruction: I.D.E.A.L. femoral tunnel position. Am. J. Orthop. (Belle Mead NJ). 2015; 44 (6): 253-8.
  19. Brown C.H.Jr., Spadling T., Robb C. Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int. Orthop. 2013; 37 (2): 253-69. doi: 10/1007/s00264-012-1772-6.
  20. Tsukada H., Ishibashi Y., Tsuda E. et al. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J. Orthop. Sci. 2008; 13 (2): 122-9. doi: 10.1007/s00776-007-1203-5.
  21. Bernard M., Hertel P., Hornung H., Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am. J. Knee Surg. 1997; 10 (1): 14-22.
  22. Wolf B.R., Ramme A.J., Britton C.L., Amendola A. Anterior cruciate ligament tunnel placement. J. Knee Surg. 2014; 27 (4): 309-17. doi: 10.1055/s-0033-1364101.
  23. Nawabi D.H., Tucker S., Schafer K.A. et al. ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am. J. Sports Med. 2016; 44 (10): 2563-71. doi: 10.1177/0363546516652876.
  24. Keller T.C., Tompkins M., Economopoulos K. et al. Tibial tunnel placement accuracy during anterior cruciate ligament reconstruction: independent femoral versus transtibial femoral tunnel drilling techniques. Arthroscopy. 2014; 30 (9): 1116-23. doi: 10.1016/j.arthro.2014.04.004.
  25. Muneta T., Yamamoto H., Ishibashi T. et al. The effects of tibia1 tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees. Arthroscopy. 1995; 11 (1): 57-62.
  26. Сучилин И.А., Маланин Д.А., Краюшкин А.И. и др. Анатомические ориентиры межмыщелковой ямки бедренной кости при пластике передней крестообразной связки. Вестник ВолгГМУ. 2012; 42 (2): 63-5.
  27. Feretti M., Ekdahl M., Shen W., Fu F.H. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy. 2007; 23 (11): 1218-25. doi: 10.1016/j.arthro.2007.09.008
  28. Маланин Д.А., Сучилин И.А., Демещенко М.В., Черезов Л.Л. Формирование бедренного туннеля при артроскопической пластике передней крестообразной связки с использованием референтных анатомических структур межмыщелковой ямки. Травматология и ортопедия России. 2013; 69 (3): 22-8. doi: 10.21823/2311-2905-2013--3-22-28.
  29. Hart A., Han Y., Martineau P.A. The apex of the deep cartilage: a landmark and new technique to help identify femoral tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy. 2015; 31 (9): 1777-83. doi: 10.1016/j.arthro.2015.03.026.
  30. Загородний Н.В., Радыш И.И., Неверкович А.С. Использование компьютерной навигации при реконструкции передней крестообразной связки. Технологии живых систем. 2011; 8 (3): 15-9.
  31. Ardern C.L., Taylor N.F., Feller J.A., Webster K.E. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am. J. Sports Med. 2012; 40 (1): 41-8. doi: 10.1177/0363546511422999.

Statistics

Views

Abstract - 36

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2018 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies