Background: Proper positioning of osseous tunnels during single bundle arthroscopic ACL reconstruction, which gives reproducibly good clinical outcome, is a matter of concern. Little evidence is there correlating tunnel position in arthroscopic ACL reconstruction with their clinical outcome in Indian population. Our aim in this study was to examine if the radiological tunnel-positions were significantly associated to the clinical outcomes.
Methods: ACL reconstruction was performed in 147 young patients with an isolated ACL tear. They were followed up prospectively for the next two years. Clinical assessment of each patient was done using the International Knee Documentation Committee (IKDC) evaluation form before surgery and at two years later the surgery. At the same time, the radiological assessment was done on standard digital radiographs.
Results: Considering the anterior and posterior-most points on the Blumensaat's line as 0% and 100% respectively the average position of the femoral tunnel was at 84.8%. Similarly, the tibial tunnel was at 46.8% along the tibial plateau. On the coronal plane the average position of the tibial tunnel was at 45.6% point along the tibial plateau (measured from the medial-most point towards laterally). The mean position of the femoral tunnel in the coronal plane was at 43.2% along the broadest part of the distal femur (measured from the lateral extent). The average inclination angle of the graft measured 19.6° (along the coronal plane).
Conclusion: Ideal clinical outcome was significantly associated with the placement of the femoral tunnel along the sagittal plane. Placement of the femoral tunnel should not be beyond the 85% mark along the Blumensaat's line from the anterior-most point. No correlation was established between clinical results and any of the remaining radiological parameters described above.
Keywords: ACL reconstruction; Clinical outcome; Radiological assessment; Single bundle; Tunnel position.
Radiologic Assessment of Femoral and Tibial Tunnel Placement Based on Anatomic Landmarks in Arthroscopic Single Bundle Anterior Cruciate Ligament ReconstructionSK Nema et al. Indian J Orthop 51 (3), 286-291. PMID 28566780.The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients.
Radiological Landmarks for Placement of the Tunnels in Single-Bundle Reconstruction of the Anterior Cruciate LigamentLA Pinczewski et al. J Bone Joint Surg Br 90 (2), 172-9. PMID 18256083.There is little evidence examining the relationship between anatomical landmarks, radiological placement of the tunnels and long-term clinical outcomes following anterior …
The Effects of Limb Alignment on Anterior Cruciate Ligament Graft Tunnel Positions Estimated From Plain RadiographsCF van Eck et al. Knee Surg Sports Traumatol Arthrosc 20 (5), 979-85. PMID 21971939.Tunnel position after anatomic double-bundle reconstruction and nonanatomic single-bundle reconstruction can be determined on lateral radiographs. However, valgus and int …
Graft Position in Arthroscopic Anterior Cruciate Ligament Reconstruction: Anteromedial Versus Transtibial TechniqueO Guler et al. Arch Orthop Trauma Surg 136 (11), 1571-1580. PMID 27484876.Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft …
A Systematic Review of Anterior Cruciate Ligament Femoral Footprint Location Evaluated by Quadrant Method for Single-Bundle and Double-Bundle Anatomic ReconstructionH Xu et al. Arthroscopy 32 (8), 1724-34. PMID 27140814. - ReviewCombined data unravel the standard position of ACL femoral origin. It can be used by clinicians to localize anatomic tunnel both in surgery and postsurgical evaluation. F …