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, 18 (1), 237

Influence of Change of Tunnel Axis Angle on Tunnel Length During Double-Bundle ACL Reconstruction via the Transportal Technique

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Influence of Change of Tunnel Axis Angle on Tunnel Length During Double-Bundle ACL Reconstruction via the Transportal Technique

Joon Ho Wang et al. BMC Musculoskelet Disord.

Abstract

Background: Commercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide.

Methods: A total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed.

Results: In the AM tunnel, tunnel axis angles in the coronal (β = 0.0252, p = 0.022) and sagittal (β = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (β = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700).

Conclusion: Drilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.

Keywords: Anterior cruciate ligament reconstruction; Femoral tunnel orientation; Quadrant method; Transportal.

Figures

Fig. 1
Fig. 1
During femoral tunneling procedure using curved guide, the change of intra-articular tunnel orientations could be allowed by the certain degrees of guide’s movement within the intercondylar notch space. a First, curved guide is positioned for targeting the intended tunnel position. b Then, the guide can be rotated within the intercondylar notch space
Fig. 2
Fig. 2
The curved guide system allows a certain degree of control over intra-articular tunnel orientation regardless of the knee flexion angle due to the rotational freedom of the guide in the intercondylar notch space. This is contrary to tunneling with a straight guide pin, which has fixed intra-articular tunnel orientation from two points, the AM or AAM portal and the femoral tunnel center
Fig. 3
Fig. 3
Angle in each plane projected from a three-dimensional surface model. a The angle between the tunnel and a line tangent to distal aspects in the coronal plane was measured. b The angle between the tunnel and a line tangent to the posterior aspects of the femoral condyles was measured in the axial plane. c The angle between the tunnel and the extended intersectional line of the femoral shaft in the sagittal plane was measured

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