title: Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first?
abstract: OBJECTIVE
  The purpose of this study was to know which tunnel--the anteromedial (AM) bundle or the posterolateral (PL) bundle--should be prepared first to create the 2 femoral tunnels accurately in anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  Thirty-four patients were divided into 2 groups of 17 depending on the sequence of preparation of the 2 femoral tunnels. In group A, the AM tunnel was prepared first, whereas the PL tunnel was prepared first in group P. ACL reconstruction was performed using a three-dimensional (3-D) fluoroscopy-based navigation system to place the double femoral tunnels through an accessory medial portal. The double femoral socket positioning was evaluated by 3-D computed tomography (CT) scan image.
  
  
  RESULTS
  The non-anatomical placement of the femoral sockets occurred in 5 patients (29%) in group A, whereas the 2 sockets were placed anatomically in all patients in group P (P < 0.05). Evaluation of the AM and the PL socket location on the 3-D CT images using the quadrant method showed more similar values to the laboratory data in a literature in group P than in group A. No complication occurred in group A, whereas complications such as socket communications or back wall blowout occurred in 5 patients (29%) in group P (P < 0.05).
  
  
  CONCLUSIONS
  The sequence of creating 2 femoral tunnels through accessory medial portal affected the resultant location of the sockets and the rate of the complications. When femoral tunnels are prepared with a transportal technique, PL tunnel first technique seems to be superior to AM first technique regarding anatomic placement. However, PL tunnel first technique accompanies the risk of socket communication.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Taketomi
authors.forename: Takumi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Takeda
authors.forename: Kohei
authors.initials: K
authors.lastname: Nakajima
authors.forename: Shuichi
authors.initials: S
authors.lastname: Nakayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukai
authors.forename: Jinso
authors.initials: J
authors.lastname: Hirota
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kachi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kawano
authors.forename: Toshiki
authors.initials: T
authors.lastname: Miura
authors.forename: Naoshi
authors.initials: N
authors.lastname: Fukui
authors.forename: Kozo
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D020679:Arthroscopes; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
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