Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 26, Issue 3 , Pages 342-350 , March 2010

Transtibial Versus Anteromedial Portal Drilling for Anterior Cruciate Ligament Reconstruction: A Cadaveric Study of Femoral Tunnel Length and Obliquity

  • Asheesh Bedi, M.D.

      Affiliations

    • Sports Medicine and Shoulder Service, New York, New York, U.S.A
    • Corresponding Author InformationAddress correspondence and reprint requests to Asheesh Bedi, M.D., Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, U.S.A.
    • ,
  • Brad Raphael, M.D.

      Affiliations

    • Sports Medicine and Shoulder Service, New York, New York, U.S.A
    • ,
  • Alex Maderazo, M.D.

      Affiliations

    • Department of Radiology and Imaging Hospital for Special Surgery, New York, New York, U.S.A
    • ,
  • Helene Pavlov, M.D.

      Affiliations

    • Department of Radiology and Imaging Hospital for Special Surgery, New York, New York, U.S.A
    • ,
  • Riley J. Williams III, M.D.

      Affiliations

    • Sports Medicine and Shoulder Service, New York, New York, U.S.A

Received 29 June 2009 ,Accepted 7 December 2009.

References 

  1. Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med. 2001;29:567–574
  2. Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE. Knee stability and graft function after anterior cruciate ligament reconstruction: A comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med. 2004;32:1825–1832
  3. Lee MC, Seong SC, Lee S, Chang CB, Park YK, Kim CH. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy. 2007;23:771–778
  4. Scopp JM, Jasper LE, Belkoff SM, Moorman CT. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy. 2004;20:294–299
  5. Chhabra A, Diduch DR, Blessey PB, Miller MD. Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy. 2004;20:328–330
  6. Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD. The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: A cadaveric study. Arthroscopy. 2007;23:1187–1192
  7. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P. Double-bundle “anatomic” anterior cruciate ligament reconstruction: A cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy. 2007;23:7–13
  8. Cha PS, Brucker PU, West RV, et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction: An anatomic approach. Arthroscopy. 2005;21:1275.e1–1275.e8www.arthroscopyjournal.org
  9. Rue JP, Ghodadra N, Lewis PB, Bach BR. Femoral and tibial tunnel position using a transtibial drilled anterior cruciate ligament reconstruction technique. J Knee Surg. 2008;21:246–249
  10. Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24:113–115
  11. Musahl V, Plakseychuk A, VanScyoc A, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: Effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med. 2005;33:712–718
  12. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy. 2003;19:297–304
  13. Simmons R, Howell SM, Hull ML. Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: An in vitro study. J Bone Joint Surg Am. 2003;85:1018–1029
  14. Arnold MP, Verdonschot N, van Kampen A. ACL graft can replicate the normal ligament's tension curve. Knee Surg Sports Traumatol Arthrosc. 2005;13:625–631
  15. Rue JP, Ghodadra N, Bach BR. Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: A cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament. Am J Sports Med. 2008;36:73–79
  16. Yasuda K, Kondo E, Ichiyama H, et al. Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy. 2004;20:1015–1025
  17. Zantop T, Haase AK, Fu FH, Petersen W. Potential risk of cartilage damage in double bundle ACL reconstruction: impact of knee flexion angle and portal location on the femoral PL bundle tunnel. Arch Orthop Trauma Surg. 2008;128:509–513
  18. Pearle AD, Shannon FJ, Granchi C, Wickiewicz TL, Warren RF. Comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation. Am J Sports Med. 2008;36:1534–1541
  19. Purnell ML, Larson AI, Clancy W. Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med. 2008;36:2083–2090
  20. Hoser C, Tecklenburg K, Kuenzel KH, Fink C. Postoperative evaluation of femoral tunnel position in ACL reconstruction: Plain radiography versus computed tomography. Knee Surg Sports Traumatol Arthrosc. 2005;13:256–262

 Supported by the Institute for Sports Medicine Research, Hospital for Special Surgery. The authors report no conflict of interest.

PII: S0749-8063(09)01078-0

doi: 10.1016/j.arthro.2009.12.006

Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 26, Issue 3 , Pages 342-350 , March 2010

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