Purpose
Our purpose was to evaluate the radiologic orientation and length of the posterolateral
(PL) femoral tunnel when drilled through the anteromedial (AM) portal at 90°, 110°,
and 130° of flexion.
Methods
In 9 fresh cadaveric knees the anterior cruciate ligament was excised and 2.4-mm guidewires
were drilled through the center of the PL bundle footprint through an accessory AM
portal. Pins were advanced, in a retrograde manner, until flush with the notch wall
and left in place. Outcomes were measured by use of plain anteroposterior, lateral,
and tunnel radiographs to determine tunnel orientation and clock position, and direct
measurement was performed to determine the intraosseous length, the shortest distance
to the posterior bone cortex, and the distance to the lateral collateral ligament
attachment on the lateral aspect of the femoral condyle.
Results
With regard to tunnel orientation, each increase in knee flexion angle resulted in
a more horizontal tunnel on both the lateral and anteroposterior views. On the tunnel
view, the PL guidewire became more vertical with knee flexion. The mean clock position
was 9 o'clock (standard deviation [SD], 00:12). No significant difference in the intraosseous
length of the guidewires was observed. According to our hypothesis, knee flexion influenced
the PL tunnel characteristics. At 90° of flexion, the guidewire may blow out the posterior
cortex of the lateral femoral condyle.
Conclusions
A PL femoral tunnel drilled through the AM portal becomes more horizontal with bending
of the knee during drilling. At 90°, the tunnel is at risk of back wall blowout.
Key Words
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Article info
Publication history
Accepted:
May 19,
2009
Received:
November 20,
2008
Footnotes
Supported in part by a research grant from Smith & Nephew, Le Mans, France. The stay of G.B. in France was supported by Smith & Nephew, Athens, Greece. Research was performed at the Anatomy Laboratory, Tours Medical University, Tours, France. The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
