title: Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique, whereas medial-portal-aiming devices with larger offset hit the center reliably.
abstract: BACKGROUND
  Aim of this study was to investigate the accuracy of a conventional over-the-top-guide (OTG) with a typically short offset to hit the center of the native femoral ACL footprint through the anteromedial portal in comparison to a specific medial-portal-aimer (MPA) with larger offset.
  
  
  METHODS
  In 20 matched human cadaveric knees, insertion sites of the ACL were marked in medial arthrotomy. An OTG with an offset of 5.5 mm, respectively, the MPA with 9 mm offset was used in a medial portal approach to locate the center of a single bundle ACL reconstruction tunnel with k-wires. Distances from the footprint center, the OTG drilling and the MPA drilling to the roof of the intercondylar notch and to the deep cartilage margin were determined. After positioning of radiological markers, radiographic analysis was performed according to the quadrant technique as described by Bernard and Hertel.
  
  
  RESULTS
  The distance from ACL origin to the roof of the notch was 10.3 (±2.1) mm, in the OTG group 6.7 (±1.5) mm and in the MPA group 9.6 (±1.9) mm. The distance to the deep cartilage margin was 9.5 (±1.7) mm from ACL origin, 4.8 (±1.3) mm with OTG and 8.7 (±1.4) mm with MPA. There were statistically significant differences between the distances of the footprint center and the OTG group after measuring and also after radiographic analysis (p < 0.0001). Using the MPA, no significant different distances in comparison to the anatomical ACL center were found (p > 0.0001). There was an increased risk for femoral blow (9/10 vs. 0/10) in the OTG group after overdrilling with a 9 mm drill.
  
  
  CONCLUSIONS
  Short (5.5 mm) offset femoral aiming devices fail to locate the native ACL footprint center in medial portal approach with an increased risk for femoral blowout when overdrilling. The special medial-portal-aiming device with 9 mm offset hit the center reliably.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Waestphaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Domnick
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Waestphaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany. mirco.herbort@uni-muenster.de.
authors.forename: Mirco
authors.initials: M
authors.lastname: Herbort
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Waestphaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Waestphaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bremer
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Waestphaelian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schliemann
authors.affiliation: Department of Traumatology, Martin Luther Hospital, Caspar-Theyss-Str. 27-31, Berlin-Grunewald, 14193, Berlin, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
authors.affiliation: Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Germany.
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D005269:Femur / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D013977:Tibia / Q000033:anatomy & histology / Q000601:surgery
keywords: Anterior cruciate ligament; Anterior cruciate ligament reconstruction, single-bundle; Medial portal technique