Purpose
To evaluate anterior cruciate ligament femoral tunnel characteristics using an accessory
medial (AM) portal and transtibial (TT) drilling.
Methods
Ten matched pairs of cadaveric knees underwent arthroscopic AM portal or TT femoral
drilling with 8-mm reamers. All knees underwent computed tomography scanning and were
evaluated for tunnel aperture area, shape as described by the length of the long and
short axes, location of the tunnel relative to the anterior and inferior aspects of
the articular surface with the knee in extension, tunnel angle in the coronal and
axial planes, and tunnel length.
Results
The femoral tunnel aperture area was 50.5 ± 4.8 mm2 for AM portal drilling and 51.9 ± 4.6 mm2 for TT drilling (P = .5). The femoral tunnel aperture long axis was 8.5 ± 1.1 mm for AM portal drilling
and 9.2 ± 1.3 mm for TT drilling (P = .2), and the short axis was 8.0 ± 0.5 mm for AM portal drilling and 8.0 ± 0.5 mm
for TT drilling (P = .8). The femoral tunnel aperture was 5.0 ± 1.4 mm from the anterior wall for AM
portal drilling and 9.9 ± 1.7 mm for TT drilling (P < .001), and it was 7.6 ± 2.4 mm from the inferior articular surface for AM portal
drilling and 8.9 ± 2.2 mm for TT drilling (P = .2). The femoral tunnel orientation in the coronal plane was 42.1° ± 4.8° for AM
portal drilling and 60.9° ± 6.7° for TT drilling (P < .001), and the orientation in the axial plane was 20.9° ± 4.4° for AM portal drilling
and 22.7° ± 13.5° for TT drilling (P = .7). The femoral tunnel length was 35.6 ± 2.8 mm for AM portal drilling and 40.3
± 7.9 mm for TT drilling (P = .1).
Conclusions
The use of an AM portal creates a tunnel more anterior and more horizontal than tunnels
created by a TT technique.
Clinical Relevance
The femoral tunnel characteristics may have an effect on the strain placed on the
graft, the graft bending angle, whether enough graft can be placed into the tunnel,
and, ultimately, the ability of the body to fully heal the graft.
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Article info
Publication history
Accepted:
October 29,
2012
Received:
March 17,
2012
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: UVA Medical Student Summer Research Project Stipend. The cadavers used for this study were donated by the International Institute for the Advancement of Medicine, Jessup, Pennsylvania.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
