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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2010 | Knee

How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction

Authors: Rainer Siebold, Ioannis S. Benetos, Nico Sartory, Zhenming He, Nawid Hariri, Hans H. Pässler

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2010

Abstract

Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is technically demanding. In order to create four anatomical anteromedial (AM) and posterolateral (PL) bone tunnels many surgeons adopt new ways of tibial and femoral bone tunnel drilling. From surgical experience, these technical changes might increase the risk for intraoperative pitfalls. An intraoperative articular cartilage damage to the medial femoral condyle or the medial tibial plateau could be disastrous for the patient. It may be caused by an insufficient anteromedial portal technique for femoral AM and PL bone tunnel drilling or flat tibial AM or PL bone tunnel reaming. Potential pitfalls may be avoided by small modifications to the surgical technique. In this present technical note, a sequence of surgical steps are described, which may help to avoid articular cartilage damage to the medial femoral condyle and medial tibial plateau in anatomical four tunnel DB ACL reconstruction.

Buoncristiani AM, Tjoumakaris PF, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006PubMedCrossRef

Colvin AC, Shen W, Musahl V, Fu FH (2009) Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 17:956–963CrossRefPubMed

Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: Part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421CrossRefPubMed

Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36CrossRefPubMed

Fu FH, Bennett CH, Lattermann C, Ma CB (1999) Current trends in anterior cruciate ligament reconstruction. Am J Sports Med 27:821–830PubMed

Harner CD, Poehling GG (2004) Double bundle or double trouble? Arthroscopy 20:1013–1014PubMedCrossRef

Harner CD, Honkamp NJ, Ranawatt AS (2008) Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 24:113–115PubMed

Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15:500–507CrossRefPubMed

Kondo E, Yasuda K, Ichiyama H, Azuma C, Tohyama H (2007) Radiologic evaluation of femoral and tibial tunnels created with the transtibial technique for anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23:869–876PubMedCrossRef

10.

Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101PubMedCrossRef

11.

Nakagawa T, Takeda H, Nakajima K, Nakayama S, Fukai A, Kachi Y, Kawano H, Miura T, Nakamura K (2008) Intraoperative 3-dimensional imaging-based navigation-assisted anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:1161–1167PubMed

12.

Nakamura M, Deie M, Shibuya H, Nakamae A, Adachi N, Aoyama H, Ochi M (2009) Potential risks of femoral tunnel drilling through the far anteromedial portal: a cadaveric study. Arthroscopy 25:481–487PubMedCrossRef

13.

Neven E, D’Hooghe P, Bellemans J (2008) Double-bundle anterior cruciate ligament reconstruction: a cadaveric study on the posterolateral tunnel position and safety of the lateral structures. Arthroscopy 24:436–440PubMedCrossRef

14.

Nishimoto K, Kuroda R, Mizuno K, Hoshino Y, Nagamune K, Kubo S, Yagi M, Yamaguchi M, Yoshiya S, Kurosaka M (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 7:270–276CrossRef

15.

Petersen W, Zantop T (2006) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47CrossRef

16.

Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574CrossRefPubMed

17.

Siebold R, Webster KE, Feller JA, Sutherland AG, Elliott J (2006) Anterior cruciate ligament reconstruction in females: a comparison of hamstring tendon and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 14:1070–1076CrossRefPubMed

18.

Siebold R, Ellert T, Metz S, Metz J (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement–a cadaver study. Arthroscopy 24:585–592PubMed

19.

Siebold R, Ellert T, Metz S, Metz J (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks and orientation model for bone tunnel placement. Arthroscopy 24:154–161PubMedCrossRef

20.

Toritsuka Y, Amano H, Kuwano M, Iwai T, Mae T, Ohzono K, Shino K (2009) Outcome of double-bundle ACL reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 17:456–463CrossRefPubMed

21.

Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMed

22.

Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef

23.

Zantop T, Haase AK, Fu FH, Petersen W (2008) Potential risk of cartilage damage in double bundle ACL reconstruction: impact of knee flexion angle and portal location on the femoral PL bundle tunnel. Arch Orthop Trauma Surg 128:509–513CrossRefPubMed

Title: How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction
Authors: Rainer Siebold
Ioannis S. Benetos
Nico Sartory
Zhenming He
Nawid Hariri
Hans H. Pässler
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2010
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-009-0967-x

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How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction

Abstract

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