Three-Dimensional Reconstruction Computed Tomography Evaluation of Tunnel Location during Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of Transtibial and 2-Incision Tibial Tunnel-Independent Techniques

Autor: Chun-Suk Ko, Jang Hwan Kim, Jin Hwan Ahn, Hwa Jae Jeong, Taeg Su Ko
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Clinics in Orthopedic Surgery
ISSN: 2005-4408
2005-291X
Popis: The transtibial technique has been wildly accepted as a gold standard in the arthroscopic anterior cruciate ligament (ACL) reconstructive surgery since its introduction. The transtibial drilling of femoral tunnels can simplify the procedure, enabling further reductions in surgical time and trauma by means of a single-incision approach. The traditional transtibial technique has been commonly used in the ACL reconstruction of the past 25 years, and its successful outcomes have been reported.1) Despite some advantages and favorable outcomes of the transtibial technique, recent researchers have questioned whether this technique sufficiently recreates the anatomy and the function of the native ACL.2) Proper positioning of the femoral tunnel during ACL reconstruction is principal, with nonanatomic tunnel placement cited as the most common cause of clinical failure secondary to pain and persistent instability.3) Inaccurate placement of femoral tunnel is a common cause of graft failure in ACL reconstruction, with the too anteriorly positioned tunnel.4) The limitations of linear surgical instrumentation coupled with the constraints imposed by tibial tunnel have often led to femoral tunnels that are vertical and nonanatomic in position.5) Although modifications to the conventional transtibial technique such as posterolateral beveling of the tibial tunnel and using a more collinear, proximal, and medial tibial starting point have been used to improve femoral tunnel positioning, these have been employed primarily with the 10 or 11 mm tunnels created for bone-patellar tendon-bone reconstructions.6,7) According to the incompleteness of the widely used methodology, many researchers have searched for a better method to improve the tunnel placement after ACL reconstruction. As a result, the technique of ACL reconstruction evolved from a traditional transtibial technique to a 2-incision tibial tunnel-independent technique, using outside-in femoral tunnel drilling.8) Recently, successful results of tibial tunnel-independent technique have been studied.5) Although more anatomical placement of femoral tunnel after tibial tunnel-independent technique was reported in several cadaver studies,9,10) it is important that these results be replicated in the clinical sample, with the technique used in the actual clinical field. We assumed that the 2-incision tibial tunnel-independent technique would allow for a more anatomic tunnel placement, as it is unconstrained by the tibial tunnel. In order to demonstrate this hypothesis, we retrospectively evaluated the three-dimensional (3D) positions of the femoral and tibial tunnels in the patients who had undergone a traditional transtibial technique and 2-incision tibial tunnel-independent technique, using 3D reconstruction computed tomography (CT). Tunnel positions of each technique were then compared with the reference data of established anatomic anteromedial and posterolateral bundle tunnel positions in the tibia and femur.
Databáze: OpenAIRE
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