title: Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study.
abstract: OBJECTIVE
  Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction.
  
  
  METHODS
  The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated.
  
  
  RESULTS
  The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane.
  
  
  CONCLUSIONS
  In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate.
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Kwang Won
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Yoon Sub
authors.initials: YS
authors.lastname: Hwang
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Yong Joo
authors.initials: YJ
authors.lastname: Chi
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Dae Suk
authors.initials: DS
authors.lastname: Yang
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Ha Yong
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Choy
keywords: Anterior cruciate ligament reconstruction; Anteromedial portal; Arthroscopy; Computed tomography; Knee