Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings.
BACKGROUND
The interest in double-bundle anterior cruciate ligament (ACL) reconstructions has recently reawakened.


OBJECTIVE
The center of the femoral posterolateral (PL) bundle and the center of the femoral anteromedial (AM) bundle are not within the same plane and change their orientation throughout passive knee flexion. Additionally, the tibial center of the AM bundle is aligned with the anterior horn of the lateral meniscus and the center of the PL bundle lies at the recommended tibial tunnel position for single-bundle ACL reconstruction reconstruction, 7 to 9 mm anterior to the posterior cruciate ligament.


METHODS
Descriptive laboratory study.


METHODS
In 20 human cadaveric knees (age range, 45-87 years) the distances from the center of the AM and PL bundle to the articular cartilage were measured. Radiographic analyses were performed using the techniques of Bernard and Hertel at the femur as well as the method by Stäubli and Rauschning at the tibia.


RESULTS
The center of the AM bundle was at a point 5.3 mm ( +/- 0.7) from the roof of the notch and 5.7 mm ( +/- 0.5) from the intercondylar line. The center of the PL bundle is located at 6.5 mm from the shallow cartilage margin and 5.8 mm from the inferior cartilage margin. On the tibia, the center of the AM bundle is aligned with the anterior horn of the lateral meniscus, while the center of the PL bundle was located 11.2 mm ( +/- 1.2) posterior and 4.1 mm ( +/- 0.6) medial to the anterior insertion of the lateral meniscus. Radiographically, the center of the PL bundle is anterior along Blumensaat's line and lower in the femoral notch along the height of the condyles than the center of the AM bundle. At the tibia, the center of the AM bundle is at 30% and the PL bundle is located at 44% using the method of Stäubli and Rauschning.


CONCLUSIONS
The center of the femoral PL bundle is shallow and inferior to the AM bundle. On the tibia, the AM bundle lies anterior when compared with the typical single-bundle ACL tunnel that reflects the PL bundle.


CONCLUSIONS
To imitate the anatomy of the intact ACL, it is mandatory to place the tunnels exactly within the femoral origin and tibial insertion of the ACL.
Zantop
Thore
T
Department of Trauma, Hand, and Reconstructive Surgery, Wilhelms University Muenster, Muenster, Germany. thore.zantop@ukmuenster.de
Wellmann
Mathias
M
Fu
Freddie H
FH
Petersen
Wolf
W
D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D005270:Femur Head / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology; D008875:Middle Aged; D011859:Radiography; D013977:Tibia / Q000033:anatomy & histology* / Q000000981:diagnostic imaging