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, 29 (1), 11-18

Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of the Anteromedial Portal and Outside-in Techniques

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Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of the Anteromedial Portal and Outside-in Techniques

Kang-Il Kim et al. Knee Surg Relat Res.

Abstract

Purpose: The purpose of this study was to compare the geometry and position of the femoral tunnel between the anteromedial portal (AMP) and outside-in (OI) techniques after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction.

Materials and methods: We evaluated 82 patients undergoing single-bundle ACL reconstruction with hamstring autografts using either the AMP (n=40) or OI (n=42) technique. The locations of the tunnel apertures were assessed by postoperative 3-dimensional computed tomography imaging. The femoral graft bending angle, femoral tunnel aperture shape, femoral tunnel length, and posterior wall breakage were also measured.

Results: The mean femoral tunnel position parallel to the Blumensaat line was more caudally positioned in the AMP group than in the OI group (p=0.025) The mean femoral graft angle in the OI group (99.6°±7.1°) was significantly more acute than that of the AMP group (108.9°±10.2°, p<0.001). The mean height/width ratio of the AMP group (1.21±0.20) was significantly more ellipsoidal than that of the OI group (1.07±0.09, p<0.001).

Conclusions: The mean femoral tunnel position was significantly shallower in the AMP technique than in the OI technique. The OI technique might be more disadvantageous than the AMP technique in terms of the more acute bending angle.

Keywords: Anterior cruciate ligament; Anteromedial portal technique; Knee; Outside-in technique; Reconstruction; Three-dimensional computed tomography.

Figures

Fig. 1
Fig. 1
Three-dimensional computed tomography of the lateral femoral side. The locations of transtibial and tibial-independent femoral tunnels were quantified and presented as the percentage distance from the deepest subchondral contour and the intercondylar notch roof to the center of the tunnel.
Fig. 2
Fig. 2
Top view of the proximal tibia. The locations of tibial tunnels were measured from the anterior border (medial to lateral) and medial border (anterior to posterior).
Fig. 3
Fig. 3
The femoral graft bending angle plane, in which the centers of the extra- and intra-articular apertures of the femoral tunnel and the center of the intra-articular aperture of the tibial tunnel were viewed together and selected to measure the femoral graft bending angle.
Fig. 4
Fig. 4
The femoral tunnel aperture shape (height/width ratio) was assessed on a cross-sectional plane parallel to the medial wall of the lateral femoral condyle near the femoral tunnel aperture.
Fig. 5
Fig. 5
Femoral tunnel positions in the anteromedial portal (AMP, black point) and outside-in (OI, white point) techniques. The mean femoral tunnel position parallel to the Blumensaat line was significantly more caudal in the AMP group (28.30±5.40) than in the OI group (25.08±7.17).

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