Height and Depth Guidelines for Anatomic Femoral Tunnels in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study
| Autor: | A. David Davis, Moiz I. Manaqibwala, Mark E. Steiner, Charles H. Brown |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Anterior cruciate ligament reconstruction Intraclass correlation medicine.medical_treatment Anterior cruciate ligament Radiography 03 medical and health sciences 0302 clinical medicine Cadaver medicine Humans Orthopedics and Sports Medicine Femur Range of Motion Articular Orthodontics 030222 orthopedics Anterior Cruciate Ligament Reconstruction business.industry Anterior Cruciate Ligament Injuries Reproducibility of Results 030229 sport sciences musculoskeletal system Surgery medicine.anatomical_structure Range of motion Cadaveric spasm business Lateral wall |
| Zdroj: | Arthroscopy: The Journal of Arthroscopic & Related Surgery. 32:1098-1105 |
| ISSN: | 0749-8063 |
| DOI: | 10.1016/j.arthro.2015.11.031 |
| Popis: | Purpose To develop guidelines for femoral tunnel placement based on height and depth on the lateral wall of the notch and to apply these guidelines arthroscopically to show tunnel placements within the anterior cruciate ligament (ACL) femoral insertion site. Methods Twelve cadaveric knees were dissected to define the centers of the femoral ACL attachment and its anteromedial (AM) and posterolateral (PL) bundles. In 90° of flexion, the height and depth of each center were determined relative to the low point on the lateral intercondylar notch. Radiographic grid measurements were made to validate these measurements. Subsequently, the measurement guidelines were applied arthroscopically in 10 new cadaveric knees to evaluate their accuracy for an anatomic single-bundle femoral tunnel. Interobserver reliability analysis was evaluated with the intraclass correlation coefficient. Results In 90° of flexion, the height of the ACL center was 8.7 ± 0.6 mm from the low point of the lateral notch; PL center, 7.2 ± 1.2 mm; and AM center, 9.6 ± 1.1 mm. Relative to the low point, the ACL center was 1.7 ± 1.7 mm posterior, the PL center was 3.4 ± 1.5 mm anterior, and the AM center was 4.9 ± 1.7 mm posterior (intraclass correlation coefficient, 0.859). Radiographic grid measurements were consistent with the direct measurements. Application of the guidelines arthroscopically with or without the assistance of a 7-mm offset aimer placed all guide pins for tunnels within the femoral ACL footprint, with 90% within 4 mm of the ACL center. Conclusions This study showed in cadaveric knees in 90° of flexion that the center of the ACL can be located on the lateral notch at a height of 8.7 ± 0.6 mm from the lowest point and anterior 11.5 ± 1.3 mm from the deepest point. How anatomic tunnels can be placed using these measurements was also shown in cadaveric knees. Clinical Relevance An anatomic femoral tunnel for ACL reconstruction can be placed using height and depth guidelines. |
| Databáze: | OpenAIRE |
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