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


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.

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About the authors

Sergei A Bantser

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

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


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