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, 51 (3), 227-232

Influence of the Different Anteromedial Portal on Femoral Tunnel Orientation During Anatomic ACL Reconstruction

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Influence of the Different Anteromedial Portal on Femoral Tunnel Orientation During Anatomic ACL Reconstruction

Dong-Kyu Moon et al. Acta Orthop Traumatol Turc.

Abstract

Objective: The purpose of this study was to evaluate the effect of femoral tunnel orientation, drilled through the accessory anteromedial (AAM) portal or the high AM portal in anatomic anterior cruciate ligament (ACL) reconstruction.

Methods: In 16 cadaver knees, using o'clock method, centers of the ACL femoral footprint were drilled with an 8-mm reamer via an AAM portal (eight knees) or a high AM portal (eight knees). Computed tomography (CT) scans were taken of each knee. Three-dimensional (3D) models were constructed to identify the femoral tunnel orientation and to create femoral tunnel virtual cylinders for measuring tunnel angles and length.

Results: In two of the 16 specimens, we observed a posterior femoral cortex blowout (PFCB) when drilling through a high AM portal. When drilled through the high AM portal, the femoral tunnel length was significantly shorter than when using an AAM portal (30.3 ± 3.8 mm and 38.2 ± 3.1 mm, p < 0.001). The femoral tunnel length was significantly shorter in the group with PFCB compared to the group with no PFCB (25.9 ± 0.6 mm and 35.5 ± 4.5 mm, p = 0.011). The axial obliquity of the high AM portal was significantly higher than that of the AAM portal (52.2 ± 5.9° and 43.0 ± 2.3°, p = 0.003).

Conclusions: In anatomic ACL reconstruction, a mal-positioned AM portal can cause abnormal tunnel orientation, which may lead to mechanical failure during ACL reconstruction. Therefore, it is important to select accurate AM portal positioning, and possibly using an AAM portal by measuring an accurate position when drilling a femoral tunnel in anatomic ACL reconstruction.

Keywords: Anterior cruciate ligament; Anteromedial; Orientation; Portal; Reconstruction.

Figures

Fig. 1
Fig. 1
Illustrative drawing of the portals. AL: anterolateral portal, AM: anteromedial portal, AAM: low accessory anteromedial portal.
Fig. 2
Fig. 2
Computed tomography scans of a posterior femoral cortex blowout (white arrow) in the (A) sagittal and (B) axial planes.
Fig. 3
Fig. 3
Three-dimensional reconstructed model of the normally orientated femur tunnel in (A) axial and (B) posterior views.
Fig. 4
Fig. 4
Tunnel length was defined as the distance (d) between the femoral extra-articular and the intra-articular tunnel apertures.
Fig. 5
Fig. 5
Femoral tunnel angles were calculated using virtual femoral tunnel cylinders projected on the (A) coronal, (B) axial, and (C) sagittal planes. The angles formed between the virtual cylinders and each plane were measured.

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