Dataset Information

Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study.

ABSTRACT: Placing the tunnels in the anatomic positions is important for successful restoration of knee function after anterior cruciate ligament reconstruction (ACLR). It has been shown that it is difficult to place the tunnels in the anatomic position using the transtibial technique. The purpose of this study was to evaluate the effect of each step of our modified transtibial technique (mTT) on the positioning of the femoral tunnel so as to assess whether the mTT could achieve anatomic placements of the tunnels without tibial tunnel expansion. Ten fresh-frozen cadaveric knees were used. First, the tibial tunnel was created in the center of ACL footprint. Then, a pin was inserted through the tibial tunnel using a femoral guide by four stepwise techniques: transtibial technique, additional anterior drawer force applied to the proximal tibia, another additional varus force applied to the tibia and finally, additional external rotation of the tibia and the femoral guide (mTT). Then, tibial tunnel was re-reamed using mTT with 10mm-diameter reamer. The pin positions in each technique on the femur were evaluated by the quadrant method and shapes of the tibial tunnel apertures were evaluated. Femoral pin positions in the four techniques were 23.6±4.5%, 28.4±3.4%, 30.1±3.8%, 33.2±4.5% in the superior-inferior position, and 23.9±4.3%, 26.2±3.7%, 32.0±4.3%, 36.9±4.8% in the anterior-posterior position, respectively. Pin position shifted to more inferior and posterior position with each step of mTT (all p values comparing superior-inferior and anterior-posterior positions of each step with positions of previous step were 0.008 or less). Using mTT, tibial tunnel aperture was 10.5±0.3mm wide and 12.9±1.1mm long. In conclusion, anatomic placements of femoral tunnels in ACLR without excessive tibial tunnel expansion could be achieved using the mTT.

SUBMITTER: Lee JK

PROVIDER: S-EPMC5536285 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study.

Lee Joon Kyu JK Lee Sahnghoon S Kim Ki Tae KT Lee Myung Chul MC

PloS one 20170731 7

Placing the tunnels in the anatomic positions is important for successful restoration of knee function after anterior cruciate ligament reconstruction (ACLR). It has been shown that it is difficult to place the tunnels in the anatomic position using the transtibial technique. The purpose of this study was to evaluate the effect of each step of our modified transtibial technique (mTT) on the positioning of the femoral tunnel so as to assess whether the mTT could achieve anatomic placements of the ...[more]

PMID: 28759600

Similar Datasets

Project description:PurposeTo evaluate the femoral and tibial tunnel positions via a modified anatomic transtibial double-bundle anterior cruciate ligament (ACL) reconstruction.MethodsPatients who underwent double-bundle ACL reconstruction using the transtibial tunnel creation technique were identified. Double-bundle ACL reconstruction was performed for 94 knees using the transtibial tunnel creation technique. Tunnel aperture configurations and center positions of the anteromedial (AM) and posterolateral (PL) tunnels via postoperative 3-dimensional computed tomography were evaluated.ResultsThere were 94 knees included. Regarding the intra-articular tunnel aperture configurations, the AM and PL tunnels overlapped at the femoral and tibial aperture in 66.0% and 94.7% cases, respectively. The mean femoral bone tunnel center was located at 23.0 ± 3.9% in the posterior-to-anterior ratio and 28.7 ± 6.0% in the proximal-to-distal ratio for the AM tunnels and at 32.8 ± 4.7% and 51.2 ± 5.2% for the PL tunnels, respectively. In the tibial tunnels, the mean AM tunnel center was located at 31.4 ± 3.6% in the anterior-to-posterior ratio and 44.3 ± 1.8% in the medial-to-lateral ratio and at 47.5 ± 3.8% and 44.3 ± 1.9% in the PL tunnel center, respectively. The femoral tunnels of outliers, both those created in nonanatomic positions as well as the posterior wall blowouts, were revealed in 7.4% cases. The nonanatomical bone tunnel group had significant heavier weight patients, lower tibial posterior slope, and were anterior in the AM and PL tunnel position. Posterior wall blowouts were related to posterior and proximal PL bone tunnel positions.ConclusionsModified transtibial double-bundle ACL reconstruction is a reliable tunnel creation technique with anatomic placement in 92.6% of the cases. The modification required that partially superimposing configuration of the 2 tibial tunnel apertures. The nonanatomic tunnels were related to patients of heavier weight and lower tibial posterior sloped knees, whereas the posterior wall blowouts were related to the posterior and proximal PL bone tunnel positions.Level of evidenceLevel IV, therapeutic case series.

Dataset Information

Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study.

Publications

Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets