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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2017

01-05-2017 | Knee

Impingement following anterior cruciate ligament reconstruction: comparing the direct versus indirect femoral tunnel position

Authors: J. P. van der List, H. A. Zuiderbaan, D. H. Nawabi, A. D. Pearle

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2017

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Abstract

Purpose

During anterior cruciate ligament (ACL) reconstruction, authors have suggested inserting the femoral tunnel at the biomechanically relevant direct fibres, but this higher position can cause more impingement. Therefore, we aimed to assess ACL graft impingement at the femoral notch for ACL reconstruction at both the direct and indirect tunnel positions.

Methods

A virtual model was created for twelve cadaveric knees with computed tomography scanning in which a virtual graft was placed at direct and indirect tunnel positions of the anteromedial bundle (AM), posterolateral bundle (PL) or centre of the both bundles (C). In these six tunnel positions, the volume (mm3) and mid-point location of impingement (°) were measured at different flexion angles.

Results

Generally, more impingement was seen with the indirect position compared with the direct position although this was only significant at 90° of flexion for the AM position (97 ± 28 vs. 76 ± 20 mm3, respectively; p = 0.046). The direct tunnel position impinged higher at the notch, whereas the indirect position impinged more towards the lateral wall, but this was only significant at 90° of flexion for the AM (24 ± 5° vs. 34 ± 4°, respectively; p < 0.001) and C position (34 ± 5° vs. 42 ± 5°, respectively; p = 0.003).

Conclusion

In this cadaveric study, the direct tunnel position did not cause more impingement than the indirect tunnel position. Based on these results, graft impingement is not a limitation to reconstruct the femoral tunnel at the insertion of the biomechanically more relevant direct fibres.
Literature
1.
Abebe ES, Kim JP, Utturkar GM, Taylor DC, Spritzer CE, Moorman CT 3rd, Garrett WE, DeFrate LE (2011) The effect of femoral tunnel placement on ACL graft orientation and length during in vivo knee flexion. J Biomech 44(10):1914–1920CrossRefPubMedPubMedCentral
2.
Allen CR, Giffin JR, Harner CD (2003) Revision anterior cruciate ligament reconstruction. Orthop Clin N Am 34(1):79–98CrossRef
3.
4.
Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S (2004) The “enthesis organ” concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum 50(10):3306–3313CrossRefPubMed
5.
Boettner F, Sculco P, Lipman J, Saboeiro G, Renner L, Faschingbauer M (2015) The effect of a low radiation CT protocol to accuracy of CT guided implant migration measurement: a Cadaver study. J Orthop Res. doi:10.​1002/​jor.​23060
6.
Brophy RH, Pearle AD (2009) Single-bundle anterior cruciate ligament reconstruction: a comparison of conventional, central, and horizontal single-bundle virtual graft positions. Am J Sports Med 37(7):1317–1323CrossRefPubMed
7.
Brophy RH, Voos JE, Shannon FJ, Granchi CC, Wickiewicz TL, Warren RF, Pearle AD (2008) Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament. Am J Sports Med 36(11):2196–2203CrossRefPubMed
8.
Colvin AC, Shen W, Musahl V, Fu FH (2009) Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 17(8):956–963CrossRefPubMed
9.
Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29(9):1566–1571CrossRefPubMed
10.
Driscoll MD, Isabell GP Jr, Conditt MA, Ismaily SK, Jupiter DC, Noble PC, Lowe WR (2012) Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy 28(10):1481–1489CrossRefPubMed
11.
Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23(11):1218–1225CrossRefPubMed
12.
Fujimoto E, Sumen Y, Deie M, Yasumoto M, Kobayashi K (2004) Anterior cruciate ligament graft impingement against the posterior cruciate ligament: diagnosis using MRI plus three—dimensional reconstruction software. Magn Reson Imaging 22(8):1125CrossRefPubMed
13.
Fung DT, Zhang L-Q (2003) Modeling of ACL impingement against the intercondylar notch. Clin Biomech 18(10):933–941CrossRef
14.
Goss BC, Howell SM, Hull ML (1998) Quadriceps load aggravates and roofplasty mitigates active impingement of anterior cruciate ligament grafts against the intercondylar roof. J Orthop Res 16(5):611–617CrossRefPubMed
15.
Goss BC, Hull ML, Howell SM (1997) Contact pressure and tension in anterior cruciate ligament grafts subjected to roof impingement during passive extension. J Orthop Res 15(2):263–268CrossRefPubMed
16.
Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S49–S55CrossRefPubMed
17.
Howell SM, Barad SJ (1995) Knee extension and its relationship to the slope of the intercondylar roof. Implications for positioning the tibial tunnel in anterior cruciate ligament reconstructions. Am J Sports Med 23(3):288–294CrossRefPubMed
18.
Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195
19.
Howell SM, Taylor MA (1993) Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg Am 75(7):1044–1055CrossRefPubMed
20.
Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19(9):931–935CrossRefPubMed
21.
Iriuchishima T, Ryu K, Aizawa S, Fu FH (2014) The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-014-3373-y
22.
Iriuchishima T, Shirakura K, Fu FH (2013) Graft impingement in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(3):664–670CrossRefPubMed
23.
Iriuchishima T, Tajima G, Ingham SJ, Shen W, Horaguchi T, Saito A, Smolinski P, Fu FH (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17(6):590–594CrossRefPubMed
24.
Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38(8):1611–1617CrossRefPubMed
25.
Iriuchishima T, Tajima G, Ingham SJ, Shirakura K, Fu FH (2012) PCL to graft impingement pressure after anatomical or non-anatomical single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 20(5):964–969CrossRefPubMed
26.
Iwahashi T, Shino K, Nakata K, Otsubo H, Suzuki T, Amano H, Nakamura N (2010) Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy 26(9 Suppl):S13–S20CrossRefPubMed
27.
Jagodzinski M, Richter GM, Passler HH (2000) Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8(1):11–19CrossRefPubMed
28.
Lane JG, Daniel DM, Stone ML (1994) Graft impingement after anterior cruciate ligament reconstruction. Presentation as an active extension “thunk”. Am J Sports Med 22(3):415–417CrossRefPubMed
29.
Li G, Papannagari R, DeFrate LE, Yoo JD, Park SE, Gill TJ (2006) Comparison of the ACL and ACL graft forces before and after ACL reconstruction: an in vitro robotic investigation. Acta Orthop 77(2):267–274CrossRefPubMed
30.
Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor award paper. Arthroscopy 19(3):297–304CrossRefPubMed
31.
Maak TG, Bedi A, Raphael BS, Citak M, Suero EM, Wickiewicz T, Pearle AD (2011) Effect of femoral socket position on graft impingement after anterior cruciate ligament reconstruction. Am J Sports Med 39(5):1018–1023CrossRefPubMed
32.
Mann TA, Black KP, Zanotti DJ, Barr M, Teater T (1999) The natural history of the intercondylar notch after notchplasty. Am J Sports Med 27(2):181–188PubMed
33.
MARS-group, Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Lantz BB, Mann BJ, Stuart MJ (2010) Descriptive epidemiology of the multicenter ACL revision study (MARS) cohort. Am J Sports Med 38(10):1979–1986CrossRef
34.
Muneta T, Yamamoto H, Ishibashi T, Asahina S, Murakami S, Furuya K (1995) The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees. Arthroscopy 11(1):57–62CrossRefPubMed
35.
Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33(5):712–718CrossRefPubMed
36.
Nishimori M, Sumen Y, Sakaridani K, Nakamura M (2007) An evaluation of reconstructed ACL impingement on PCL using MRI. Magn Reson Imaging 25(5):722CrossRefPubMed
37.
Norwood LA Jr, Cross MJ (1977) The intercondylar shelf and the anterior cruciate ligament. Am J Sports Med 5(4):171–176CrossRefPubMed
38.
Noyes FR, Keller CS, Grood ES, Butler DL (1984) Advances in the understanding of knee ligament injury, repair, and rehabilitation. Med Sci Sports Exerc 16(5):427–443CrossRefPubMed
39.
Palmer I (1938) On the injuries to the ligaments of the knee joint: a clinical study. Clin Orthop Relat Res 454:17–22 (discussion 14) CrossRef
40.
Pathare NP, Nicholas SJ, Colbrunn R, McHugh MP (2014) Kinematic analysis of the indirect femoral insertion of the anterior cruciate ligament: implications for anatomic femoral tunnel placement. Arthroscopy 30(11):1430–1438CrossRefPubMed
41.
Sasaki N, Ishibashi Y, Tsuda E, Yamamoto Y, Maeda S, Mizukami H, Toh S, Yagihashi S, Tonosaki Y (2012) The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy 28(8):1135–1146CrossRefPubMed
42.
Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20(3):294–299CrossRefPubMed
43.
Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussiere C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19(2):196–201CrossRefPubMed
44.
Voos JE, Musahl V, Maak TG, Wickiewicz TL, Pearle AD (2010) Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc 18(9):1282–1289CrossRefPubMed
45.
Wetzler MJ, Bartolozzi AR, Gillespie MJ, Rubenstein DL, Ciccotti MG, Miller LS (1996) Revision anterior cruciate ligament reconstruction. Oper Tech Orthop 6(3):181CrossRef
46.
Yamamoto Y (2004) Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med 32(8):1825–1832CrossRefPubMed
47.
Zuiderbaan HA, Khamaisy S, Nawabi DH, Thein R, Nguyen JT, Lipman JD, Pearle AD (2014) Notchplasty in anterior cruciate ligament reconstruction in the setting of passive anterior tibial subluxation. Knee 21(6):1160–1165CrossRefPubMed
Metadata
Title
Impingement following anterior cruciate ligament reconstruction: comparing the direct versus indirect femoral tunnel position
Authors
J. P. van der List
H. A. Zuiderbaan
D. H. Nawabi
A. D. Pearle
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3897-9

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