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BMC Musculoskeletal Disorders

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Open Access 01-12-2008 | Research article

Double-bundle ACL reconstruction: influence of femoral tunnel orientation in knee laxity analysed with a navigation system – an in-vitro biomechanical study

Authors: Stefano Zaffagnini, Danilo Bruni, Sandra Martelli, Naoaki Imakiire, Maurilio Marcacci, Alessandro Russo

Published in: BMC Musculoskeletal Disorders | Issue 1/2008

Abstract

Background

This paper reports an in-vitro study for evaluating the influence of the femoral tunnel orientation in anterior cruciate ligament (ACL) double-bundle reconstructions.

Methods

This work describes the experimental protocol and results obtained for six cadaver knees using the FlashPoint optical system (Image Guided, Boulder, Colorado, USA) and a computer-assisted technique for the elaboration of anatomical and kinematic data. Each specimen was examined by the same surgeon in the following steps: (1) intact knee stability was evaluated by performing antero-posterior displacement and internal-external rotation test at 90°; (2) the ACL was resected and the knee evaluated again; (3) the ACL was reconstructed using the gracilis semi-tendinous tendon (through horizontal tunnels in femur), and the new kinematics recorded; (4) the ACL was reconstructed again with the same tendon, but with a more vertical orientation of the femoral tunnel (vertical tunnel) and kinematics was once more recorded; (5) finally the knee was dissected to digitise the anatomical structures.

Results

Off-line computer analysis of the acquired anatomical and kinematic data showed that there was a significant statistical difference (Wilcoxon test with the Montecarlo method for small samples – p = 0.035) between horizontal tunnel (HT) and vertical tunnel (VT) reconstruction both in the antero-posterior test (median antero-posterior displacement in horizontal tunnel was 0.8 mm less than in vertical tunnel reconstruction) and in the internal-external (IE) rotation test (median internal-external rotation in horizontal tunnel reconstruction was 5° less than in vertical tunnel reconstruction).

Conclusion

The analysis of graft behavior in reconstructed knees compared with normal and ACL-deficient knees suggests that the most horizontal tunnel performed better than the vertical tunnel, thus constraining optimally both antero-posterior and internal-external rotations. This finding suggests that femoral tunnel direction may be an important issue in ACL surgery.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/9/25/prepub

Title: Double-bundle ACL reconstruction: influence of femoral tunnel orientation in knee laxity analysed with a navigation system – an in-vitro biomechanical study
Authors: Stefano Zaffagnini
Danilo Bruni
Sandra Martelli
Naoaki Imakiire
Maurilio Marcacci
Alessandro Russo
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2008
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-9-25

At a glance: The STEP trials

Springer Medicine

Double-bundle ACL reconstruction: influence of femoral tunnel orientation in knee laxity analysed with a navigation system – an in-vitro biomechanical study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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