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Knee Surgery, Sports Traumatology, Arthroscopy

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01-02-2014 | Knee

Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis

Authors: H. Van der Bracht, J. Bellemans, J. Victor, L. Verhelst, B. Page, P. Verdonk

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2014

Abstract

Purpose

To analyze anatomical risk factors and surgical technique dependent variables, which determine the risk for femoral notch impingement in anatomically correct placed tibial tunnels for anterior cruciate ligament (ACL) surgery.

Methods

Twenty fresh frozen adult human knee specimens under the age of 65 years were used. Digital templates mimicking a tibial tunnel aperture at the tibia plateau were designed for different tibial tunnel diameters and different drill-guide angles. The centres of these templates were placed over the geometric centre of the native tibial ACL footprint. The distances between the anterior borders of the templates and the anterior borders of the footprints (graft free zone) were measured and compared. Furthermore, anatomic risk factors for femoral notch impingement were determined.

Results

The graft free zone was statistically significantly longer for larger drill-guide angles compared to smaller drill-guide angles (p < 0.00001). Furthermore, 8 mm diameter tibial tunnels had a statistically significant larger graft free zone compared to 10-mm-diameter tibial tunnels (p < 0.00001). For the 10 mm diameter tibial tunnels with drill-guide angle of 45°, 9 out of 20 knees (45 %) were “at risk” for notching and 4 out of 20 knees (20 %) had “definite” notching. For 10-mm tunnels with drill-guide angle of 45°, a risk for notching was associated with smaller tibial ACL footprint (p < 0.05).

Conclusion

If a perfect centrally positioned tibial tunnel is drilled, a real risk for femoral notch impingement exists depending on the size of the tibial ACL footprint and surgery-related factors. Therefore, in anatomical tibial tunnel placement in single bundle ACL reconstruction surgery, particular attention should be paid to size of the tunnel and drill-guide angle to minimize the risk of femoral notch impingement.

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Title: Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis
Authors: H. Van der Bracht
J. Bellemans
J. Victor
L. Verhelst
B. Page
P. Verdonk
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2393-3

At a glance: The STEP trials

Springer Medicine

Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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