Evaluating for Tunnel Convergence in Anterior Cruciate Ligament Reconstruction With Modified Lemaire Tenodesis: What Is the Best Tunnel Angle to Decrease Risk?

Autor:	Perelli S; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: perelli.simone@gmail.com., Erquicia JI; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain., Ibañez M; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain., Daesino G; Interventional and Diagnostic Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Gelber PE; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital de la Sta Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Pelfort X; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Consorci Sanitari de l'Anoia, Hospital de Igualada, Barcelona, Spain., Monllau JC; Institut Català de Traumatologia i Medicina de l'Esport-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2020 Mar; Vol. 36 (3), pp. 776-784. Date of Electronic Publication: 2019 Dec 18.
DOI:	10.1016/j.arthro.2019.08.042
Abstrakt:	Purpose: The purpose of this study was to analyze postoperative computed tomography (CT) scan evaluations of patients who had undergone a combined anterior cruciate ligament (ACL) reconstruction and modified Lemaire anterolateral tenodesis (ALT) with femoral fixation through a bony tunnel. Methods: Postoperative CT scans of 52 patients who had undergone combined ACL and ALT were prospectively evaluated. ACL femoral tunnels were drilled through an anteromedial portal in the center of the native footprint. An ALT fixation tunnel was drilled 5 mm proximal to the lateral epicondyle, aiming at an inclination of 30° proximally and 30° anteriorly. Two independent observers evaluated the CT scans measuring any degree of collision, the shortest distance between the tunnels, and the inclination of the ALT tunnels. Measurements were carried out at both the cortical level and on a plane passing 1 cm deeper in the lateral condyle. Results: At the level of the cortex, no convergence of the tunnels was identified. In 14 of 52 cases (26.9%), the shortest distance between the tunnels was less than 5 mm. Tunnel collision occurred in 8 of 52 cases (15.4%), and the bone bridge between the tunnels was less than 5 mm in 11 cases (21.1%) when the measurements were made on the deeper plane. When the inclination on the axial plane was less than 15°, a collision always (P < .001) occurs. When it was more than 20°, no collision occurred (P < .001). No correlation between convergence and the inclination of the ALT tunnel on the coronal plane was detected. Conclusions: To fix a modified Lemaire ALT through a femoral tunnel avoiding any interference with an anatomic femoral ACL tunnel, we recommend that the femoral tunnel be drilled with an inclination of at least 20° anteriorly. Level of Evidence: IV, therapeutic case series. (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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