Effect of femoral tunnel position on graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament reconstruction.
OBJECTIVE
To evaluate the effect of the femoral tunnel position of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) on the graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.


METHODS
Forty-five patients who underwent anatomic double-bundle ACL reconstruction were included. AMB and PLB were provisionally fixed to a graft tensioning system in the following settings during surgery: (1) AMB at 20° and PLB at 0° (A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45° (A20P45). Bundle tension was recorded during knee flexion-extension. A pivot shift test was also evaluated. Femoral tunnel positions of the AMB and PLB were then assessed by three-dimensional computed tomography, and the correlation between femoral tunnel position and tension change pattern or residual pivot shift was evaluated.


RESULTS
The depth of the PLB tunnel position was correlated with the extent of tension reduction in the PLB between 0° and 30° irrespective of graft fixation settings, while neither the AMB tunnel position nor the height of the PLB tunnel position affected the tension change pattern. Ten cases showed grade 1 pivot shift only in the A20P0 setting. The PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases (27.5 ± 6.2 and 34.1 ± 5.5%, respectively, P = 0.002).


CONCLUSIONS
In anatomic double-bundle reconstruction, deeper PLB tunnel position was correlated with the larger tension reduction in the PLB between 0° and 30°. Fixation of the AMB at 20° and the PLB at 0° resulted in residual pivot shift phenomenon in 10/45 cases, and the PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases. In anatomic double-bundle reconstruction, the placement of PLB femoral tunnel must not be too deep, as it might lead to significant tension reduction in the PLB near extension and thus insufficient tension in the PLB, resulting in residual pivot shift phenomenon.


METHODS
IV.
Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan, koga-z@rg7.so-net.ne.jp.
Hideyuki
H
Koga
Takeshi
T
Muneta
Kazuyoshi
K
Yagishita
Toshifumi
T
Watanabe
Tomoyuki
T
Mochizuki
Masafumi
M
Horie
Tomomasa
T
Nakamura
Ichiro
I
Sekiya
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D013710:Tendons / Q000637:transplantation; D014182:Transplantation, Autologous; D055815:Young Adult