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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2011

01-08-2011 | Knee

Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique

Authors: Jeff R. S. Leiter, Nevin de Korompay, Lindsey MacDonald, Sheila McRae, Warren Froese, Peter B. MacDonald

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2011

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Abstract

Purpose

To compare the reliability of tibial tunnel position and angle produced with a standard ACL guide (two-dimensional guide) or Howell 65° Guide (three-dimensional guide) in the coronal and sagittal planes. In the sagittal plane, the dependent variables were the angle of the tibial tunnel relative to the tibial plateau and the position of the tibial tunnel with respect to the most posterior aspect of the tibia. In the coronal plane, the dependent variables were the angle of the tunnel with respect to the medial joint line of the tibia and the medial and lateral placement of the tibial tunnel relative to the most medial aspect of the tibia.

Methods

The position and angle of the tibial tunnel in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken 2–6 months postoperatively. The two-dimensional and three-dimensional guide groups included 28 and 24 sets of radiographs, respectively. Tibial tunnel position was identified, and tunnel angle measurements were completed. Multiple investigators measured the position and angle of the tunnel 3 times, at least 7 days apart.

Results

The angle of the tibial tunnel in the coronal plane using a two-dimensional guide (61.3 ± 4.8°) was more horizontal (P < 0.05) than tunnels drilled with a three-dimensional guide (64.7 ± 6.2°). The position of the tibial tunnel in the sagittal plane was more anterior (P < 0.05) in the two-dimensional (41.6 ± 2.5%) guide group compared to the three-dimensional guide group (43.3 ± 2.9%).

Conclusion

The Howell Tibial Guide allows for reliable placement of the tibial tunnel in the coronal plane at an angle of 65°. Tibial tunnels were within the anatomical footprint of the ACL with either technique. Future studies should investigate the effects of tibial tunnel angle on knee function and patient quality of life.

Level of evidence

Case–control retrospective comparative study, Level III.
Literature
1.
Arneja S, Froese W, MacDonald P (2004) Augmentation of femoral fixation in hamstring anterior cruciate ligament reconstruction with a bioabsorbable bead: a prospective single-blind randomized clinical trial. Am J Sports Med 32:159–163PubMedCrossRef
2.
Arnold MP, Verdonschot N, van Kampen A (2005) ACL graft can replicate the normal ligament’s tension curve. Knee Surg Sports Traumatol Arthrosc 13:625–631PubMedCrossRef
3.
Ayerza MA, Muscolo DL, Costa-Paz M, Makino A, Rondon L (2003) Comparison of sagittal obliquity of the reconstructed anterior cruciate ligament with native anterior cruciate ligament using magnetic resonance imaging. Arthroscopy 19:257–261PubMedCrossRef
4.
Basdekis G, Christel P, Anne F (2009) Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with three-dimensional CT scan. Knee Surg Sports Traumatol Arthrosc 17:1089–1094PubMedCrossRef
5.
Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ 3rd (2010) Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy 26:342–350PubMedCrossRef
6.
Birmingham TB, Bryant DM, Giffin JR, Litchfield RB, Kramer JF, Donner A, Fowler PJ (2008) A randomized controlled trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction. Am J Sports Med 36:648–655PubMedCrossRef
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 36:2196–2203PubMedCrossRef
8.
Cuomo P, Edwards A, Giron F, Bull AM, Amis AA, Aglietti P (2006) Validation of the 65° Howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75PubMedCrossRef
9.
Fu FH, Harner CD, Johnson DL, Miller MD, Woo SL (1994) Biomechanics of knee ligaments: basic concepts and clinical application. Instr Course Lect 43:137–148PubMed
10.
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–S55PubMedCrossRef
11.
Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195PubMed
12.
Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29:567–574PubMed
13.
Inoue M, Tokuyasu S, Kuwahara S, Yasojima N, Kasahara Y, Kondo E, Onodere S, Yasuda K (2010) Tunnel location in transparent three-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique. Knee Surg Sports Traumatol Arthrosc 18:1176–1183PubMedCrossRef
14.
Ishii Y, Ohmori G, Bechtold JE, Sherman RE, Gustilo RB (1995) Accuracy of the short radiograph in the measurement of the tibiofemoral angle. Knee 2:81–84CrossRef
15.
Johnson RJ, Beynnon BD, Nichols CE, Renstrom PA (1992) The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg Am 74:140–151PubMed
16.
Kobayashi M, Nakagawa Y, Suzuki T, Okudaira S, Nakamura T (2006) A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur. Arthroscopy 22:1093–1099PubMedCrossRef
17.
Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431PubMedCrossRef
18.
Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH (2009) A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17:213–219PubMedCrossRef
19.
Lee MC, Seong SC, Lee S, Chang CB, Park YK, Jo H, Kim CH (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23:771–778PubMedCrossRef
20.
Marks P, O’Donnell S, Yee G (2008) A pilot clinical evaluation comparing the mitek bone-tendon-bone cross pin and bioabsorbable screw in anterior cruciate ligament reconstruction fixation, a randomized double blind controlled trial. Knee 15:168–173PubMedCrossRef
21.
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 33:712–718PubMedCrossRef
22.
Patel DV, Ferris BD, Aichroth PM (1991) Radiological study of alignment after total knee replacement. Short radiographs or long radiographs? Int Orthop 15:209–210PubMed
23.
Romano VM, Graf BK, Keene JS, Lange RH (1993) Anterior cruciate ligament reconstruction. The effect of tibial tunnel placement on range of motion. Am J Sports Med 21:415–418PubMedCrossRef
24.
Saowaprut S, Tanpowpong T, Piyaskulkaew C (2009) Correlation of graft position, knee laxity and clinical outcome: comparison with native anterior cruciate ligament using magnetic resonance imaging study. J Med Assoc Thai 92:510–516PubMed
25.
Segawa H, Omori G, Tomita S, Koga Y (2001) Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 9:206–210PubMedCrossRef
26.
Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg Am 85:1018–1029PubMed
27.
Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129PubMedCrossRef
28.
Watanabe BM, Howell SM (1995) Arthroscopic findings associated with roof impingement of an anterior cruciate ligament graft. Am J Sports Med 23:616–625PubMedCrossRef
Metadata
Title
Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique
Authors
Jeff R. S. Leiter
Nevin de Korompay
Lindsey MacDonald
Sheila McRae
Warren Froese
Peter B. MacDonald
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1397-0

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