Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleValidation of a New Technique to Determine Midbundle Femoral Tunnel Position in Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography Analysis
Section snippets
Methods
Fifty-five consecutive, functionally unstable, ACL-deficient patients underwent ACL reconstruction by use of a femoral tunnel in the anatomic position on the medial wall of the lateral femoral condyle with the described technique. CT scans were performed postoperatively, and reconstructive images were used to measure the tunnel position as referenced from the posterior aspect of the lateral femoral condyle and the roof of the intercondylar notch. The precise details of the anatomic technique
Results
There were 55 patients in the anatomic group operated on between September 2009 and April 2010. Five patients in this group did not attend their CT scan appointments and so were excluded. This left a total of 50 patients. Sixteen patients undergoing ACL reconstruction by the traditional technique were also evaluated. The mean patient age at surgery was 30 years (range, 16 to 66 years) in the anatomic group and 33 years (range, 21 to 62 years) in the traditional group. There were 38 male and 12
Discussion
We have described a new technique to reliably position the femoral tunnel in the midbundle position of the ACL insertion on the lateral wall of the intercondylar notch. An arthroscopic ruler is used to measure the depth of the lateral wall, and the tunnel is drilled at the midpoint of this line. Quantification of the center of the resulting tunnel on specific 3D CT scan reconstructions has shown that the technique reproducibly places the tunnel close to the anatomic center of the insertion as
Conclusions
The ruler technique produced femoral tunnels comparable to published radiographic criteria used for tunnel placement and is reproducible and accurate. We recommend placement of the femoral tunnel at the midpoint of the lateral femoral condyle when using the anatomic single-bundle technique.
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Can Surgeons Identify ACL Femoral Ridges Landmark and Optimal Tunnel Position? A 3D Model Study
2020, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Often, an ACL stump is present and may influence tunnel placement in anatomic reconstruction. Newer techniques using soft-tissue landmarks have been studied and validated such as measuring from the proximal articular cartilage.21 This method was further supported by recent reconstruction studies of the lateral femoral condyle, which showed it to be as reliable as the lateral intercondylar ridge.21
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The authors report no conflict of interest.