Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study.
The objective of this study was to investigate the accurate AM and PL tunnel positions in an anatomical double-bundle ACL reconstruction using human cadaver knees with an intact ACL. Fifteen fresh-frozen non-paired adult human knees with a median age of 60 were used. AM and PL bundles were identified by the difference in tension patterns. First, the center of femoral PL and AM bundles were marked with a K-wire and cut from the femoral insertion site. Next, each bundle was divided at the tibial side, and the center of each AM and PL tibial insertion was again marked with a K-wire. Tunnel placement was evaluated using a C-arm radiographic device. For the femoral side assessment, Bernard and Hertel's technique was used. For the tibial side assessment, Staubli's technique was used. After radiographic evaluations, all tibias' soft tissues were removed with a 10% NaOH solution, and tunnel placements were evaluated. In the radiographic evaluation, the center of the femoral AM tunnel was placed at 15% in a shallow-deep direction and at 26% in a high-low direction. The center of the PL bundle was found at 32% in a shallow-deep direction and 52% in a high-low direction. On the tibial side, the center of the AM tunnel was placed at 31% from the anterior edge of the tibia, and the PL tunnel at 50%. The ACL tibial footprint was placed close to the center of the tibia and was oriented sagittally. AM and PL tunnels can be placed in the ACL insertions without any coalition. The native ACL insertion site has morphological variety in both the femoral and tibial sides. This study showed, anatomically and radiologically, the AM and PL tunnel positions in an anatomical ACL reconstruction. We believe that this study will contribute to an accurate tunnel placement during ACL reconstruction surgery and provide reference data for postoperative radiographic evaluation.
Iriuchishima
Takanori
T
Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building suite 1010, Pittsburgh, PA 15213, USA.
Ingham
Sheila J M
SJ
Tajima
Goro
G
Horaguchi
Takashi
T
Saito
Akiyoshi
A
Tokuhashi
Yasuaki
Y
Van Houten
Albert H
AH
Aerts
Maarten M
MM
Fu
Freddie H
FH
D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology* / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D002102:Cadaver; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013977:Tibia / Q000033:anatomy & histology* / Q000601:surgery*
Arthroscopy. 2001 Sep;17(7):708-16
11536089
Arthroscopy. 2003 Mar;19(3):297-304
12627155
Knee Surg Sports Traumatol Arthrosc. 1994;2(3):138-46
7584195
Arthroscopy. 2009 May;25(5):464-72
19409303
Am J Knee Surg. 1997 Winter;10(1):14-21; discussion 21-2
9051173
Knee Surg Sports Traumatol Arthrosc. 2009 Apr;17(4):347-51
19023561
Arthroscopy. 2008 May;24(5):585-92
18442692
Arthroscopy. 2008 Feb;24(2):154-61
18237698
J Biomech. 2006;39(13):2371-7
16199046
Arthroscopy. 2006 Jun;22(6):683.e1-5
16762715
Knee Surg Sports Traumatol Arthrosc. 2008 Aug;16(8):741-6
18481044
Am J Sports Med. 2008 Nov;36(11):2083-90
18663150
Knee Surg Sports Traumatol Arthrosc. 2009 Jun;17(6):590-4
19089408
Am J Sports Med. 2008 Jan;36(1):65-72
17932407
Knee Surg Sports Traumatol Arthrosc. 2009 Jul;17(7):782-5
19333575
Knee Surg Sports Traumatol Arthrosc. 2001 Jul;9(4):194-9
11522073
Arthroscopy. 2006 Sep;22(9):1000-6
16952731
Knee Surg Sports Traumatol Arthrosc. 2007 Dec;15(12):1414-21
17934717
Arthroscopy. 2007 Nov;23(11):1218-25
17986410
Arthroscopy. 2007 Jun;23(6):618-28
17560476
Arthroscopy. 2008 Apr;24(4):436-40
18375276
Scand J Med Sci Sports. 2007 Aug;17(4):387-92
16805782
Knee Surg Sports Traumatol Arthrosc. 2007 Dec;15(12):1422-31
17899008
J Orthop Sci. 2008 Mar;13(2):122-9
18392916
Am J Sports Med. 2008 Jul;36(7):1263-74
18354141
Knee Surg Sports Traumatol Arthrosc. 2008 Jan;16(1):29-36
17957351
J Bone Joint Surg Am. 2009 Apr;91(4):859-66
19339570
Am J Sports Med. 2008 Jan;36(1):176-89
18166680
Arthroscopy. 2006 Mar;22(3):240-51
16517306
Arthroscopy. 2006 Sep;22(9):984-92
16952729
Arthroscopy. 2007 Jan;23(1):7-13
17210421
Am J Sports Med. 2002 Sep-Oct;30(5):660-6
12238998