title: Femoral tunnel apertures on the lateral cortex in anterior cruciate ligament reconstruction: an analysis of cortical button fixation.
abstract: OBJECTIVE
  If the aperture of the oval-shaped femoral tunnel on the lateral cortex becomes bigger than half the size of the cortical button, the risk of fixation failure increases. This study investigated the effect of the location of the entry point and diameter of the femoral tunnel on the length of the major axis of the tunnel aperture in anterior cruciate ligament (ACL) reconstruction using an outside-in technique.
  
  
  METHODS
  Simulation of femoral tunnel drilling was performed on computed tomography (CT)-based 3-dimensional (3D) bone models obtained from 40 participants. The tunnel connected the center of the ACL footprint and various points on the lateral femoral surface. The diameter of the tunnel was set at 4.2 mm, 5.2 mm, or 6 mm, depending on the commercially available outside-in surgical systems (Arthrex, Naples, FL and Smith & Nephew, Andover, MA). The length of the major axis of the oval-shaped aperture on the lateral femoral surface was measured.
  
  
  RESULTS
  When the tunnel was introduced at 2 cm from the lateral epicondyle in a 45° anteroproximal direction, the major axis was lengthened to 130.7% ± 9.0% (P < .001) of the tunnel diameter, and it was more than 6.5 mm in 65% of participants in whom a 5.2-mm-diameter tunnel was drilled. When the entry point was 3 cm from the lateral epicondyle, 60% of participants had an oval-shaped aperture with a major axis of more than 6.5 mm, even though the diameter of the tunnel was only 4.2 mm.
  
  
  CONCLUSIONS
  The risk of fixation failure of a cortical button increases if the entry point for drilling is 2 cm or further from the lateral epicondyle and the tunnel diameter is more than 5 mm.
  
  
  CONCLUSIONS
  This study indicates the potential risk of cortical button fixation failure caused by an oval tunnel aperture on the lateral femoral surface in ACL reconstruction using the outside-in technique.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: okazaki@med.kyushu-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okazaki
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Matsubara
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Osaki
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tashiro
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mizu-Uchi
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamai
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed