scholarly journals Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery – A cadaveric study

2016 ◽  
Vol 50 (5) ◽  
pp. 514-518 ◽  
Author(s):  
Ahmet Karakasli ◽  
Nihat Acar ◽  
Onur Basci ◽  
Ahmet Karaarslan ◽  
Mehmet Erduran ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Lateral Meniscus ◽  
Cadaveric Study ◽  
Anterior Horn ◽  
Tunnel Placement ◽  
Reconstruction Surgery

scholarly journals Anterior versus Posterior Tibial Tunnel Placement in ACL Reconstruction

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
Mark D. Miller ◽  
Michael S. Laidlaw ◽  
Kadir Buyukdogan
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Tibial Tunnel ◽  
Lateral Meniscus ◽  
Anterior Horn ◽  
Posterior Border ◽  
Thigh Circumference ◽  
Posterior Group ◽  
Kt 1000 ◽  
Anterior Knee

Objectives: Previously, we reported that the use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction resulted in a wide variation of tunnel location in the sagittal plane. The effects of such tibial tunnel variations on functional outcomes have not been previously reported. Hypothesis: Anteriorly placed tibial tunnels lead to better anterior knee stability than posteriorly placed tunnels. Study Design: Cohort study, Level of evidence 3. Methods: 71 patients (aged 18-55) underwent isolated unilateral anatomic single bundle primary ACL reconstruction with quadrupled hamstring tendons or bone patellar tendon bone autografts between March 2013 and June 2014 by the same surgeon using an accessory medial portal technique. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained and these were digitally analyzed to measure the location of the pin along the length of the tibial plateau using the method described by Amis and Jakob. The patients were divided into two groups—one anterior and the other posterior to 40% of the tibial plateau length. Side-to-side difference in anterior knee translation (KT-1000), thigh circumference, range of motion, IKDC and Marx activity scale were evaluated and compared between the groups at a minimum of 2 years following ACL reconstructive surgery. Results: 50 patients (26 in the anterior group and 24 in the posterior group) were avaliable for follow-up at a mean of 2.5 years. There was no difference in the terms of age, sex, BMI, loss of extension, graft type (Hams-BPTB) and size (mm) between the groups (p>.05). In terms of stability, the mean side-to-side difference was 0.19±1.3 mm for anterior group and 1.27 ±1.3 mm for posterior group based on KT-1000 measurements (P<.005). The IKDC (75.1±4.1 vs 79.2±2.8) and Marx activity (6.6±1.05 vs 8.3±1.04) scores were similar in both groups. No difference in thigh circumference was found between the involved and uninvolved extremities of the both groups (-1.48±1.41 vs -1.52±1.17). Conclusion: Using the posterior border of the anterior horn of the lateral meniscus as a landmark yields a wide range of tibial tunnel locations along the tibial plateau. Anterior placement of the tibial tunnel leads to better anterior knee stability than posterior placement does.

Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

2021 ◽  
Author(s):  
Iskandar Tamimi ◽  
David Bautista Enrique ◽  
Motaz Alaqueel ◽  
Jimmy Tat ◽  
Almudena Pérez Lara ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Case Control Study ◽  
Lateral Meniscus ◽  
Case Control ◽  
Lateral Tibial Plateau ◽  
Reconstruction Surgery ◽  
Meniscus Height ◽  
Nested Case Control ◽  
Control Study

AbstractPrevious work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweightbearing maximum height of the posterior horn of both menisci was measured on the T1 sagittal scans. Measurements of the medial and lateral tibial slope and meniscal slope were then taken from the sagittal T1 scans passing through the center of the medial and lateral tibial plateau. A binary logistic regression analysis was done to calculate crude and adjusted odds ratios (ORs) estimates. Thirty-four cases who underwent ACL revision surgery were selected and were matched with 68 controls. Cases had a lower lateral meniscal height (6.39 ± 1.2 vs. 7.02 ± 0.9, p = 0.008, power = 84.4%). No differences were found between the two groups regarding the bone slope of the lateral compartment (6.19 ± 4.8 vs. 6.92 ± 5.8, p = 0.552), the lateral meniscal slope (–0.28 ± 5.8 vs. –1.03 ± 4.7, p = 0.509), and the anteroposterior distance of the lateral tibial plateau (37.1 ± 5.4 vs. 35.6 ± 4, p = 0.165). In addition, no differences were found in the medial meniscus height between cases and controls (5.58 ± 1.2 vs. 5.81 ± 1.2, respectively, p = 0.394). There were also no differences between cases and controls involving the medial bone slope, medial meniscal slope, or anterior posterior distance of the medial tibial plateau. Female patients had a higher medial (4.8 degrees ± 3.2 vs. 3.3 ± 4.1, p = 0.047) and lateral (8.1 degrees ± 5.1 vs. 5.6 degrees  ± 5.6, p = 0.031) tibial bone slope, and a lower medial (5.3 mm ± 1.0 vs. 6.1 mm ± 1.2, p = 0.001) and lateral (6.6 ± 1.0 vs. 7.0 ± 1.2, p = 0.035) meniscus height, and medial (4.3 ± 0.4 vs. 4.8 ± 0.4, p =0.000) and lateral (3.3 ± 0.3 vs. 3.9 ± 0.4, p = 0.000) anteroposterior distance than males, respectively.The adjusted OR of suffering an ACL reconstruction failure compared to controls was 5.1 (95% confidence interval [CI]: 1.7–14.9, p = 0.003) for patients who had a lateral meniscus height under 6.0 mm. The adjusted OR of suffering an ACL reconstruction failure was 2.4 (95% CI: 1.0–7.7, p = 0.01) for patients who had an anteroposterior distance above 35.0 mm. Patients with a lateral meniscal height under 6.0 mm have a 5.1-fold risk of suffering an ACL reconstruction failure compared to individuals who have a lateral meniscal height above 6.0 mm. Patients with a higher anteroposterior distance of the lateral tibial plateau also have a higher risk of ACL reconstruction failure.

scholarly journals Radiological assessment of femoral and tibial tunnel placement in arthroscopic ACL reconstruction using hamstring tendon graft

2020 ◽  
Vol 6 (2) ◽  
pp. 563-568
Author(s):  
Dr. Rajesh Naidu P ◽  
Dr. M Krishna Chaitanya ◽  
Dr. Ambareesh P ◽  
Dr. Sheikh Mohammed Fahim ◽  
Dr. Gowtham Reddy
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Radiological Assessment ◽  
Hamstring Tendon Graft ◽  
Tunnel Placement

scholarly journals DOES ACL TUNNEL PLACEMENT AFFECT QUALITY OF LIFE IN ADOLESCENTS?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0004
Author(s):  
Brandon Tauberg ◽  
Ronen Sever ◽  
Regina Hanstein ◽  
Eric Fornari
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Tibial Tunnel ◽  
Self Report ◽  
Tunnel Placement ◽  
Secondary Surgery ◽  
Tourniquet Time ◽  
Pain Scores ◽  
Outcome Scores ◽  
Tunnel Angle

Purpose: The aim of this study was to evaluate the influence of surgical experience of an orthopaedic surgeon on femoral and tibial tunnel placement during anterior cruciate ligament (ACL) reconstruction, and the effect of tunnel angle on patient self-report outcomes. Methods: We retrospectively reviewed 115 consecutive ACL reconstruction surgeries by a single fellowship-trained orthopaedic surgeon over his first 5 years in practice. 70 patients with hamstring (HS) and 44 patients with bone-patellar tendon-bone (BTB) autografts were included, all epiphyseal approaches, graft hybrids or allografts were excluded. Posterior distal femoral angle (PDFA), femoral and tibial tunnel angulation were measured on AP and lateral radiographs by 2 independent raters with high inter-rater reliability (ICC >0.8 for all measures). Tunnel angulation was compared to recently reported ideal femoral angle of 33.5°±1.8 or ideal tibial angle of 62.5°±5 (Luthringer et al, 2016). Complications and self-report outcomes - pediIKDC, Tegner-Lysholm and KOOSChild - were recorded, as well as demographics, injury and surgery characteristics (e.g. concurrent meniscal repairs, chondroplasty, tourniquet time). Average follow-up was 1.14 years. Continuous variables were analyzed using unpaired t-test, Wilcoxon rank sum test and Spearman correlation. Categorical variables were analyzed using Fisher’s exact test. Results: ACL reconstruction was performed at an average age of 16.7 years (range, 11.8 to 20.4 years), 59% males. Figure 1 shows tunnel angles over case groups of N=15. For HS autografts, femoral tunnel angle and tibial tunnel angle improved toward the ideal angle after 15 cases (ANOVA, p=0.020 and p=0.031, respectively). For BTB autografts, femoral tunnel angle and tibial tunnel angle did not demonstrate a significant change over cases (Figure 1). The tibial tunnel angle in HS cases showed a negative weak correlation with the selected outcome scores at 6 months and 1 year after ACL reconstruction, whereas the tibial tunnel angle in BTB cases showed a weak positive correlation with KOOSChild pain scores 6 months after initial surgery (Table 1). For either graft type, femoral tunnel angle was not correlated with any outcome measure. Overall, self-report outcome scores were similar between patients with ideal and non-ideal tunnel angles (data not shown). Of the 70 patients with HS autografts, 5 (7%) required a secondary surgery: 2 revisions for graft tear, 1 revision for a non-functional graft, 1 for arthrofibrosis and 1 for a prominent tibial screw. PDFA, femoral and tibial tunnel angle were similar between patients needing secondary surgery and those who did not (Table 2). Patients needing revision surgery had significantly lower Tegner-Lysholm and KOOSChild Pain scores at 6 months after the initial ACL reconstruction. Of the 44 BTB patients, 3 (6.8%) had complications: 2 patients developed arthrofibrosis and subsequently underwent surgery, and 1 patient experienced neuropathy. In these patients, the PDFA was significantly higher, the femoral tunnel angle significantly lower and tibial tunnel angle similar compared to those without a complication (Table 2). Demographic factors, injury and surgical parameters (concurrent meniscal repairs, chondroplasty, tourniquet time, aso) were similar between HS patients with or without additional surgery and between BTB patients with and without complications. Conclusion/Significance: Femoral and tibial tunnel angle improved towards the reported ideal angle after 15 cases for HS autografts. PDFA, femoral and tibial tunnel angle were not associated with surgical complications in HS patients. For BTB autografts, no significant changes were seen in tunnel placement with surgical experience. Patients experiencing complications after BTB autografts had a low femoral tunnel angle and high PDFA. Overall, tibial tunnel angle, but not femoral tunnel angle, correlated with outcome scores of patients with BTB and HS autografts. [Figure: see text][Table: see text][Table: see text]

Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Bunsei Goto
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Single Bundle ◽  
Tunnel Placement ◽  
Anterior Border ◽  
Medial Border ◽  
Tibial Spine ◽  
Anterior Cruciate ◽  
Tibia Plateau

AbstractThe purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Using postoperative 3D-CT, accurate axial views of the tibia plateau were evaluated. By assuming the medial and anterior borders of the tibia plateau as 0% and the lateral and posterior borders as 100%, the location of the medial and lateral tibial spine, and the center of the tibial tunnel were calculated. Statistical analysis was performed to assess the correlation between tibial spine location and tibial tunnel placement. The medial tibial spine was located at 54.7 ± 4.5% from the anterior border and 41.3 ± 3% from the medial border. The lateral tibial spine was located at 58.7 ± 5.1% from the anterior border and 55.3 ± 2.8% from the medial border. The ACL tibial tunnel was located at 34.8 ± 7.7% from the anterior border and 48.2 ± 3.4% from the medial border. Mediolateral tunnel placement was significantly correlated with medial and lateral tibial spine location. However, for anteroposterior tunnel placement, no significant correlation was found. A significant correlation was observed between mediolateral ACL tibial tunnel placement and medial and lateral tibial spine location. For clinical relevance, tibial ACL tunnel placement might be unintentionally influenced by tibial spine location. Confirmation of the ACL footprint is required to create accurate anatomical tunnels during surgery. This is a Level III; case–control study.

scholarly journals ACL Roof Impingement Revisited: Does the Independent Femoral Drilling Technique Avoid Roof Impingement With Anteriorly Placed Tibial Tunnels?

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770415 ◽  
Author(s):  
John A. Tanksley ◽  
Brian C. Werner ◽  
Evan J. Conte ◽  
David P. Lustenberger ◽  
M. Tyrrell Burrus ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acl Reconstruction ◽  
Clinical Studies ◽  
Femoral Tunnel ◽  
Tibial Tunnel ◽  
Attachment Site ◽  
Tunnel Placement ◽  
Anterior Tibial ◽  
Drilling Technique ◽  
Graft Angle

Background: Anatomic femoral tunnel placement for single-bundle anterior cruciate ligament (ACL) reconstruction is now well accepted. The ideal location for the tibial tunnel has not been studied extensively, although some biomechanical and clinical studies suggest that placement of the tibial tunnel in the anterior part of the ACL tibial attachment site may be desirable. However, the concern for intercondylar roof impingement has tempered enthusiasm for anterior tibial tunnel placement. Purpose: To compare the potential for intercondylar roof impingement of ACL grafts with anteriorly positioned tibial tunnels after either transtibial (TT) or independent femoral (IF) tunnel drilling. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaver knees were randomized to either a TT or IF drilling technique. Tibial guide pins were drilled in the anterior third of the native ACL tibial attachment site after debridement. All efforts were made to drill the femoral tunnel anatomically in the center of the attachment site, and the surrogate ACL graft was visualized using 3-dimensional computed tomography. Reformatting was used to evaluate for roof impingement. Tunnel dimensions, knee flexion angles, and intra-articular sagittal graft angles were also measured. The Impingement Review Index (IRI) was used to evaluate for graft impingement. Results: Two grafts (2/6, 33.3%) in the TT group impinged upon the intercondylar roof and demonstrated angular deformity (IRI type 1). No grafts in the IF group impinged, although 2 of 6 (66.7%) IF grafts touched the roof without deformation (IRI type 2). The presence or absence of impingement was not statistically significant. The mean sagittal tibial tunnel guide pin position prior to drilling was 27.6% of the sagittal diameter of the tibia (range, 22%-33.9%). However, computed tomography performed postdrilling detected substantial posterior enlargement in 2 TT specimens. A significant difference in the sagittal graft angle was noted between the 2 groups. TT grafts were more vertical, leading to angular convergence with the roof, whereas IF grafts were more horizontal and universally diverged from the roof. Conclusion: The IF technique had no specimens with roof impingement despite an anterior tibial tunnel position, likely due to a more horizontal graft trajectory and anatomic placement of the ACL femoral tunnel. Roof impingement remains a concern after TT ACL reconstruction in the setting of anterior tibial tunnel placement, although statistical significance was not found. Future clinical studies are planned to develop better recommendations for ACL tibial tunnel placement. Clinical Relevance: Graft impingement due to excessively anterior tibial tunnel placement using a TT drilling technique has been previously demonstrated; however, this may not be a concern when using an IF tunnel drilling technique. There may also be biomechanical advantages to a more anterior tibial tunnel in IF tunnel ACL reconstruction.

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