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Remnant-Preserving Tibial Tunnel Positioning Using Anatomic Landmarks in Double-Bundle Anterior Cruciate Ligament Reconstruction
- Source :
- Arthroscopy: The Journal of Arthroscopic & Related Surgery. 32:1822-1830
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Purpose To assess (1) if 6 anatomic landmarks (ALs) could be arthroscopically confirmed with remnant preservation and (2) if creating tibial tunnels using these landmarks reduces individual variation and improves reproducibility in double-bundle anterior cruciate ligament (ACL) reconstruction. Methods We retrospectively reviewed data of patients who chronologically underwent double-bundle ACL reconstruction by either referencing the footprint after remnant dissection (non-AL group) or subsequently with the ALs (AL group). Using operative videos, 3 independent observers judged whether they could confirm 6 ALs (medial intercondylar ridge, medial and lateral intercondylar tubercles, anterior horn of lateral meniscus, Parsons' knob, and L-shaped ridge) in 20 patients randomly selected from the AL group. We then compared tunnel positions between the 2 groups, measured from the anterior and medial borders of the proximal tibia and expressed as percentage of the total depth and width of the proximal tibia using 3-dimensional computed tomography. Results One hundred four patients (non-AL group, n = 54; AL group, n = 50) were included. All 6 ALs were arthroscopically confirmed in most cases (89.7% to 100%). The mean percentages of the anteroposterior (AP) depth for anteromedial (AM) tunnel, mediolateral (ML) width for AM tunnel, AP depth for posterolateral (PL) tunnel, and ML width for PL tunnel, respectively, were 27.8% ± 6.6%, 46.7% ± 2.8%, 41.4% ± 7.3%, and 46.1% ± 2.6% for the non-AL group and 30.7% ± 4.5%, 45.7% ± 2.2%, 45.2% ± 4.5%, and 46.9% ± 2.1% for the AL group, revealing significantly less variation in the AL group compared with the non-AL group, excluding the ML width of the PL tunnel ( P = .007, .046, .002, .209, respectively). Conclusions Six landmarks could be reliably confirmed in cases with remnant preservation, and creating tibial tunnels using these landmarks were reproducible and resulted in less individual variation. Level of Evidence Level III, retrospective comparative study.
- Subjects :
- Adult
Male
Adolescent
Knee Joint
Anterior cruciate ligament reconstruction
Anterior cruciate ligament
medicine.medical_treatment
Arthroscopy
Young Adult
03 medical and health sciences
0302 clinical medicine
Double bundle
Humans
Medicine
Orthopedics and Sports Medicine
Tibia
Retrospective Studies
Lateral meniscus
030222 orthopedics
Anterior Cruciate Ligament Reconstruction
medicine.diagnostic_test
business.industry
Tibial tunnel
Videotape Recording
030229 sport sciences
Anatomy
Middle Aged
Dissection
medicine.anatomical_structure
Female
Anatomic Landmarks
business
Subjects
Details
- ISSN :
- 07498063
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Arthroscopy: The Journal of Arthroscopic & Related Surgery
- Accession number :
- edsair.doi.dedup.....1102f2e38684ba5fb654606b0e7df6b4