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, 53 (4), 397-403
eCollection

Radiological Evaluation of the Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction

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Radiological Evaluation of the Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction

Luciano Rodrigo Peres et al. Rev Bras Ortop.

Abstract

Objective: To evaluate the inclination and the length of the femoral tunnel in patients submitted to anterior cruciate ligament reconstruction (ACL) surgery by transtibial and anatomical techniques.

Methods: This is an analytical observational study in patients with ACL injury that underwent arthroscopic reconstruction through transtibial and anatomical surgical techniques. In the immediate postoperative period, computed tomography (CT) and anteroposterior (AP) view digital radiographs (X-rays) were performed to evaluate the inclination and length of the femoral tunnel.

Results: Forty-two patients were analyzed: 27 underwent anatomical reconstruction and 15, transtibial reconstruction. The inclination angle and tunnel length by the transtibial technique are always greater than by the anatomical technique. The mean inclination angles were 59.75° (53.9-66.1°) in the X-rays and 54.17° (43.5-62.3°) in CT for the transtibial technique, and 42.91° (29.3-57.4°) in the X-rays and 39.10° (23.8-50.6°) in CT for the anatomical technique. Regarding the length of the femoral tunnel, the transtibial technique promotes longer tunnels: mean 55.7 mm (40.0-70.2 mm) in the transtibial and 35.5 mm (24.5-47 mm) in the anatomical technique. No statistically significant correlation was observed between the length and the inclination of the tunnel, regardless of the technique used. Thus, these variables can be considered as independent.

Conclusion: The anatomical reconstruction technique presented shorter femoral tunnels and lower angle of inclination than the transtibial technique. The CT showed smaller inclination angle than the X-rays, regardless of the surgical technique.

Keywords: Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Computed tomography by X-rays; Knee joint; Radiography.

Figures

Fig. 1
Fig. 1
Measurement of femoral tunnel inclination on X-ray.
Fig. 2
Fig. 2
Measurement of femoral tunnel inclination on CT.
Fig. 3
Fig. 3
Measurement of femoral tunnel length on CT.
Fig. 4
Fig. 4
Comparison of angles measured by X-ray and CT according to the surgical technique.
Fig. 5
Fig. 5
Comparison between angle and tunnel length by surgical technique.
Fig. 6
Fig. 6
Boxplot of the techniques by age, angle on X-ray and CT, and tunnel length.

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