title: Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury.
abstract: OBJECTIVE
  This study sought to determine the safety limits for performing a femoral bone tunnel to reconstruct the knee anterolateral ligament (ALL) by establishing its distance from the lateral collateral ligament (LCL) and the popliteus muscle tendon (PT) on the lateral femoral condyle.
  
  
  METHODS
  Anatomic study on 48 knee cadaveric specimens. The femoral attachments of the studied structures were isolated, and the distance between them was measured. For each cadaver, the percentage of cases in which at least 50 % of the LCL and PT would be injured when using 4- to 12-mm-diameter drills in an ALL reconstruction procedure was evaluated.
  
  
  RESULTS
  The LCL and PT were 3.8 mm and 10.2 mm distant from the ALL, respectively. A 4-mm tunnel would cause LCL injury in 8.3 % of cases, with increasing incidence of injury up to 87.5 % with a 12-mm drill. Injury to the PT would start with the 10-mm drill, causing injury in 2.0 % of cases.
  
  
  CONCLUSIONS
  Performing a tunnel in the center of the ALL may cause an iatrogenic injury to the LCL origin. No cases of PT injury are expected to occur with drills smaller than 10 mm.
authors.affiliation: University of São Paulo, São Paulo, Brazil. camilo_helito@yahoo.com.br.
authors.forename: Camilo Partezani
authors.initials: CP
authors.lastname: Helito
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Batista
authors.initials: MB
authors.lastname: Bonadio
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Riccardo Gomes
authors.initials: RG
authors.lastname: Gobbi
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Roberto Freire
authors.initials: RF
authors.lastname: da Mota E Albuquerque
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: José Ricardo
authors.initials: JR
authors.lastname: Pécora
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Gilberto Luis
authors.initials: GL
authors.lastname: Camanho
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Marco Kawamura
authors.initials: MK
authors.lastname: Demange
mesh_terms: D002102:Cadaver; D017885:Collateral Ligaments / Q000293:injuries / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000209:etiology; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D013708:Tendon Injuries / Q000209:etiology* / Q000601:surgery
keywords: Anatomy; Anterolateral ligament; Anterolateral ligament reconstruction; Knee instability; Lateral collateral ligament; Popliteus muscle tendon