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Comparisons of tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction

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Abstract

Purpose

Our aim was to evaluate tunnel-graft angle, tunnel length and position and change in graft length between transtibial (30 patients) and anteromedial (30 patients) portal techniques using 3D knee models after anterior cruciate ligament (ACL) reconstruction.

Methods

The 3D angle between femoral or tibial tunnels and graft at 0° and 90° flexion were compared between groups. We measured tunnel lengths and positions and evaluated the change in graft length from 0° to 90° flexion.

Results

The 3D angle at the femoral tunnel with graft showed a significant difference between groups at 0° flexion (p = 0.01) but not at 90° flexion (p = 0.12). The 3D angle of the tibial tunnel showed no significant differences between groups. Femoral tunnel length in the transtibial group was significantly longer than in the transportal group (40.7 vs 34.7 mm,), but tibial tunnel length was not. The relative height of the lateral femoral condyle was significantly lower in the transportal than the transtibial group (24.1 % vs 34.4 %). No significant differences were found between groups in terms of tibial tunnel position. The change in graft length also showed no significant difference between groups.

Conclusion

Even though the transportal technique in ACL reconstruction can place the femoral tunnel in a better anatomical position than the transtibial technique, it has risks of a short femoral tunnel and acute angle at the femoral tunnel. Moreover, there was also no difference in the change of the graft length between groups.

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References

  1. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86-A:2143–2155

    PubMed  Google Scholar 

  2. Lee MC, Seong SC, Lee S et al (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23:771–778

    Article  PubMed  Google Scholar 

  3. Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N et al (2012) Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction? Knee Surg Sports Traumatol Arthrosc 20:743–751

    Article  PubMed  Google Scholar 

  4. Brown CH Jr, Spalding T, Robb C (2013) Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop 37:253–269

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lim HC, Yoon YC, Wang JH, Bae JH (2012) Anatomical versus nonanatomical single bundle anterior cruciate ligament reconstruction: a cadaveric study of comparison of knee stability. Clin Orthop Surg 4:249–255

    Article  PubMed  PubMed Central  Google Scholar 

  6. van Eck CF, Schreiber VM, Mejia HA et al (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–S12

    Article  PubMed  Google Scholar 

  7. Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(9 Suppl):S21–S34

    Article  PubMed  Google Scholar 

  8. Zaffagnini S, Bruni D, Marcheggiani Muccioli GM et al (2011) Single-bundle patellar tendon versus nonanatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19:390–397

    Article  PubMed  Google Scholar 

  9. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23:7–13

    Article  PubMed  Google Scholar 

  10. Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH (2013) Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg 5:26–35

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20:2200–2207

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yau WP, Fok AW, Yee DK (2013) Tunnel positions in transportal versus transtibial anterior cruciate ligament reconstruction: a case-control magnetic resonance imaging study. Arthroscopy 29:1047–1052

    Article  PubMed  CAS  Google Scholar 

  13. Wang JH, Kim JG, do Lee K, Lim HC, Ahn JH (2012) Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1584–1593

    Article  PubMed  Google Scholar 

  14. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ 3rd (2010) Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy 26:342–350

    Article  PubMed  Google Scholar 

  15. Chang CB, Yoo JH, Chung BJ, Seong SC, Kim TK (2010) Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med 38:1237–1245

    Article  PubMed  Google Scholar 

  16. Miller CD, Gerdeman AC, Hart JM et al (2011) A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction. Arthroscopy 27:372–379

    Article  PubMed  Google Scholar 

  17. Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27:391–398

    Article  PubMed  Google Scholar 

  18. Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1014–21; discussion 21–12

  19. Cooper DE, Stewart D (2004) Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2–10-year follow-up. Am J Sports Med 32:346–360

    Article  PubMed  Google Scholar 

  20. McAllister DR, Hussain SM (2010) Tibial inlay posterior cruciate ligament reconstruction: surgical technique and results. Sports Med Arthrosc 18:249–253

    Article  PubMed  Google Scholar 

  21. Nishimoto K, Kuroda R, Mizuno K et al (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 17:270–276

    Article  PubMed  Google Scholar 

  22. Basdekis G, Abisafi C, Christel P (2008) Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Arthroscopy 24(4):459–464

    Article  PubMed  Google Scholar 

  23. Noh JH, Roh YH, Yang BG, Yi SR, Lee SY (2013) Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: transtibial technique versus anteromedial portal technique. Arthroscopy 29:882–890

    Article  PubMed  Google Scholar 

  24. Tudisco C, Bisicchia S (2012) Drilling the femoral tunnel during ACL reconstruction: transtibial versus anteromedial portal techniques. Orthopedics 35:e1166–e1172

    Article  PubMed  Google Scholar 

  25. Yoo YS, Jeong WS, Shetty NS, Ingham SJ, Smolinski P, Fu F (2010) Changes in ACL length at different knee flexion angles: an in vivo biomechanical study. Knee Surg Sports Traumatol Arthrosc 18:292–297

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by a grant (2012–3149) from the Chonnam National University

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Authors and Affiliations

  1. Department of Orthopedic Surgery, centre for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-809, South Korea

    Eun-Kyoo Song, Sung-Kyu Kim, Hong-An Lim & Jong-Keun Seon

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  1. Eun-Kyoo Song
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  2. Sung-Kyu Kim
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Correspondence to Jong-Keun Seon.

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Song, EK., Kim, SK., Lim, HA. et al. Comparisons of tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction. International Orthopaedics (SICOT) 38, 2357–2362 (2014). https://doi.org/10.1007/s00264-014-2457-0

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  • DOI: https://doi.org/10.1007/s00264-014-2457-0

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