title: Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament.
abstract: There is little evidence examining the relationship between anatomical landmarks, radiological placement of the tunnels and long-term clinical outcomes following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the reproducibility of intra-operative landmarks for placement of the tunnels in single-bundle reconstruction of the ACL using four-strand hamstring tendon autografts. Isolated reconstruction of the ACL was performed in 200 patients, who were followed prospectively for seven years with use of the International Knee Documentation Committee forms and radiographs. Taking 0% as the anterior and 100% as the posterior extent, the femoral tunnel was a mean of 86% (sd 5) along Blumensaat's line and the tibial tunnel was 48% (sd 5) along the tibial plateau. Taking 0% as the medial and 100% as the lateral extent, the tibial tunnel was 46% (sd 3) across the tibial plateau and the mean inclination of the graft in the coronal plane was 19 degrees (sd 5.5). The use of intra-operative landmarks resulted in reproducible placement of the tunnels and an excellent clinical outcome seven years after operation. Vertical inclination was associated with increased rotational instability and degenerative radiological changes, while rupture of the graft was associated with posterior placement of the tibial tunnel. If the osseous tunnels are correctly placed, single-bundle reconstruction of the ACL adequately controls both anteroposterior and rotational instability.
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Highway, Crows Nest, Sydney, Australia.
authors.forename: L A
authors.initials: LA
authors.lastname: Pinczewski
authors.forename: L J
authors.initials: LJ
authors.lastname: Salmon
authors.forename: W F M
authors.initials: WF
authors.lastname: Jackson
authors.forename: R B P
authors.initials: RB
authors.lastname: von Bormann
authors.forename: P G
authors.initials: PG
authors.lastname: Haslam
authors.forename: S
authors.initials: S
authors.lastname: Tashiro
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D015203:Reproducibility of Results; D013709:Tendon Transfer / Q000379:methods*; D013710:Tendons / Q000000981:diagnostic imaging / Q000502:physiology; D016896:Treatment Outcome