title: How to avoid collision between PCL and MCL femoral tunnels during a simultaneous reconstruction.
abstract: OBJECTIVE
  The purpose of the present study was to assess the risk of femoral tunnel collisions between the medial collateral ligament (MCL) and the posterior cruciate ligament (PCL) tunnels during a simultaneous PCL and MCL reconstruction.
  
  
  METHODS
  Fourth generation medium and large synthetic femur bones were used. On each femur, a MCL tunnel and a PCL tunnel were reamed. The MCL tunnel was drilled at 0°, 20° and 40° of axial and coronal angulations. The PCL femoral tunnel was reamed to simulate two different tunnel directions that could be obtained through an inside-out and outside-in technique. Tunnels were filled with epoxy resin augmented with BaSO4, and a multidetector CT examination of each specimen was performed.
  
  
  RESULTS
  High rate of tunnel collision (62.5 %) was found when the MCL femoral tunnel was reamed with a coronal angulation of 0° and 20°. The rate of tunnel collision significantly decreased (0 %) when the MCL tunnel was reamed proximally with a coronal angulation of 40°. No differences were found between the two PCL tunnel directions in terms of tunnel collision.
  
  
  CONCLUSIONS
  The results of this study can help surgeons to better direct the femoral MCL tunnel in order to avoid a collision between femoral tunnels during a combined MCL and PCL reconstruction. In order to minimize such potential complications, the MCL tunnel should be created limiting the axial angulation and it should be drilled with a proximal angulation from 20° to 40°, depending on the medial condyle width.
authors.affiliation: Department of Orthopaedic Surgery, DICHIRONS, University of Palermo, Via del Vespro, 90100, Palermo, Italy. lawrence.camarda@unipa.it.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Camarda
authors.affiliation: Department of Radiology, DIBIMEF, University of Palermo, Via del Vespro, 90100, Palermo, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Grassedonio
authors.affiliation: Department of Orthopaedic Surgery, DICHIRONS, University of Palermo, Via del Vespro, 90100, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Lauria
authors.affiliation: Department of Radiology, DIBIMEF, University of Palermo, Via del Vespro, 90100, Palermo, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.affiliation: Department of Orthopaedic Surgery, DICHIRONS, University of Palermo, Via del Vespro, 90100, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Arienzo
mesh_terms: D005269:Femur / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D008953:Models, Anatomic; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D000072229:Posterior Cruciate Ligament Reconstruction / Q000009:adverse effects*
keywords: Combined ligament reconstruction; MCL PCL; Medial collateral ligament; Medial collateral ligament reconstruction; Multiple ligament reconstruction; Posterior cruciate ligament reconstruction