title: The graft/femoral tunnel angles in posterior cruciate ligament reconstruction: a comparison of 3 techniques for femoral tunnel placement.
abstract: This study compared the graft/femoral tunnel angle produced with the outside-in technique with the inside-out technique at 90 degrees and 120 degrees of flexion. Three femoral tunnels were marked with guidewires and measured radiographically in 8 fresh-frozen cadaveric knees using both techniques. Results were analyzed. The mean graft/femoral tunnel angle was 34.4 degrees +/- 14.4 degrees for the outside-in technique, 52.3 degrees +/- 14.1 degrees for the inside-out technique at 120 degrees of flexion, and 74.4 degrees +/- 11 degrees for the inside-out technique at 90 degrees of flexion. The angle was smaller for the outside-in technique versus the inside-out technique at both 120 degrees (P = .019) and 90 degrees of knee flexion (P < .001). The outside-in technique for femoral tunnel placement produces the lowest graft/femoral tunnel angle in cadavers. With the inside-out technique, 120 degrees of flexion produces smaller angles than does 90 degrees of flexion. The outside-in technique results in lower angles and perhaps lower graft failure rates. However, additional clinical studies are needed.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Schoderbek
authors.forename: S Raymond
authors.initials: SR
authors.lastname: Golish
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Rubino
authors.forename: Jason A
authors.initials: JA
authors.lastname: Oliviero
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D001696:Biomechanical Phenomena; D002102:Cadaver; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery / Q000637:transplantation*; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*