title: Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system.
abstract: BACKGROUND
  Previous studies have identified the femoral attachment of the posterior cruciate ligament fibers as one of the primary determinants of fiber tension behavior. In addition, a double-bundle posterior cruciate ligament reconstruction has been shown to restore the intact knee kinematics more closely than does a single-bundle reconstruction.
  
  
  OBJECTIVE
  An anterior tunnel position in double-bundle posterior cruciate ligament reconstruction restores the biomechanics of the normal knee more closely than does a posterior tunnel position.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Kinematics and in situ forces of human knees after double-bundle posterior cruciate ligament reconstruction with 2 different femoral tunnel positions (anterior vs posterior) were evaluated using a robotic/universal force-moment sensor testing system. Within the same specimen, the resulting knee kinematics and in situ forces were compared. For statistical analysis, 2-way analysis of variance repeated measures were performed.
  
  
  RESULTS
  The femoral tunnel position of the double-bundle hamstring graft had significant effect on the resulting posterior tibial displacement and in situ forces of the hamstring grafts. The anterior femoral tunnel position provided significantly less posterior tibial translation than did the posterior tunnel position. There was a tendency toward higher in situ forces of grafts fixed in the anterior tunnel when compared to the posterior position, but this difference was statistically not significant.
  
  
  CONCLUSIONS
  An anterior position of the bone tunnels in double-bundle posterior cruciate ligament reconstruction restores the normal knee kinematics more closely than does a posterior position of the tunnels.
  
  
  CONCLUSIONS
  In double-bundle posterior cruciate ligament reconstruction, posterior placement of the tunnel should be avoided.
authors.affiliation: Department of Trauma-, Hand-, and Reconstructive Surgery, Wilhelms University Muenster, Waldeyerstr. 1, D-48149 Muenster, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
authors.forename: Simon
authors.initials: S
authors.lastname: Lenschow
authors.forename: Andre
authors.initials: A
authors.lastname: Weimann
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strobel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005858:Germany; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D012371:Robotics / Q000295:instrumentation*