Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2014 | Knee

The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports

Authors: Tiago Lazzaretti Fernandes, Felipe Fregni, Kayleen Weaver, André Pedrinelli, Gilberto Luis Camanho, Arnaldo José Hernandez

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2014

Abstract

Purpose

The purpose of this study was to radiographically investigate the influence of femoral tunnel placement in ACL reconstruction on early outcomes and return to sports due to anatomic and nonanatomic positioning.

Methods

A prospective study was conducted from 2008 to 2010, with 86 athletes who underwent ACL reconstruction between anteromedial (AM) footprint and high AM position. Knee functional outcomes (IKDC objective and subjective, Tegner score, and Lysholm scale) return to sports and complications were analyzed at 6- and 12-month follow-up.

Results

At follow-up, it was observed that tunnel projection along Blumensaat’s line was correlated with functional outcomes on Tegner scale (at 6 and 12 months) and IKDC subjective (at 12 months). There was a significant difference in mean tunnel projection along Blumensaat’s line when analyzing return to sports (73 ± 1.4 and 79 ± 1.7 %, respectively, for projections on return vs. no return to sports, p = 0.02) and complications (73 ± 1.3 vs. 78 ± 1.6 %, respectively, for projections on no complications vs. complications, p = 0.03). No differences were stated on coronal view. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics.

Conclusion

The clinical relevance of this study is that tunnel positioning along AM footprint and high AM position represented by tunnel projection along Blumensaat’s line is associated with early return to sports on previous Tegner level and better functional outcome in athletes.

Level of evidence

III.

Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86:2143–2155PubMed

Bedi A, Maak T, Musahl V, O’Loughlin P, Choi D, Citak M, Pearle AD (2011) Effect of tunnel position and graft size in single-bundle anterior cruciate ligament reconstruction: an evaluation of time-zero knee stability. Arthroscopy 27:1543–1551PubMedCrossRef

Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21PubMed

Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R (2007) ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res 458:180–187PubMed

Bicer EK, Lustig S, Servien E, Selmi TA, Neyret P (2010) Current knowledge in the anatomy of the human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 18:1075–1084PubMedCrossRef

Dargel J, Pohl P, Tzikaras P, Koebke J (2006) Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat 28:398–402PubMedCrossRef

Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227PubMedCrossRef

Eriksson K, Anderberg P, Hamberg P, Löfgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354PubMedCrossRef

Fernandes TL, Protta TR, Fregni F, Neto RB, Pedrinelli A, Camanho GL, Hernandez AJ (2012) Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:275–280PubMedCrossRef

10.

Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426PubMedCrossRef

11.

Good L, Odensten M, Gillquist J (1987) Precision in reconstruction of the anterior cruciate ligament. A new positioning device compared with hand drilling. Acta Orthop Scand 58:658–661PubMedCrossRef

12.

Gougoulias N, Khanna A, Griffiths D, Maffulli N (2008) ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 15:486–490PubMedCrossRef

13.

Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R (1994) Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 10:502–512PubMedCrossRef

14.

Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35:1708–1715PubMedCrossRef

15.

Jansson KA, Linko E, Sandelin J, Harilainen A (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31:12–18PubMed

16.

Jepsen CF, Lundberg-Jensen AK, Faunoe P (2007) Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy 23:1326–1333PubMedCrossRef

17.

Johnson DS, Smith RB (2001) Outcome measurement in the ACL deficient knee–what’s the score? Knee 8:51–57PubMedCrossRef

18.

Jonsson H, Elmqvist LG, Kärrholm J, Tegner Y (1994) Over-the-top or tunnel reconstruction of the anterior cruciate ligament? A prospective randomised study of 54 patients. J Bone Joint Surg Br 76:82–87PubMed

19.

Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique. Am J Sports Med 39:2016–2026PubMedCrossRef

20.

Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24:335–341PubMedCrossRef

21.

Klos TV, Harman MK, Habets RJ, Devilee RJ, Banks SA (2000) Locating femoral graft placement from lateral radiographs in anterior cruciate ligament reconstruction: a comparison of 3 methods of measuring radiographic images. Arthroscopy 16:499–504PubMedCrossRef

22.

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

23.

Kopf S, Pombo MW, Shen W, Irrgang JJ, Fu FH (2011) The ability of 3 different approaches to restore the anatomic anteromedial bundle femoral insertion site during anatomic anterior cruciate ligament reconstruction. Arthroscopy 27:200–206PubMedCrossRef

24.

Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 16:1009–1016PubMedCrossRef

25.

Leiter JR, de Korompay N, Macdonald L, McRae S, Froese W, Macdonald PB (2011) Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique. Knee Surg Sports Traumatol Arthrosc 19:1258–1264PubMedCrossRef

26.

Lewis PB, Parameswaran AD, Rue JP, Bach BR Jr (2008) Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med 36:2028–2036PubMedCrossRef

27.

Metsavaht L, Leporace G, Riberto M, de Mello Sposito MM, Batista LA (2010) Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. Am J Sports Med 38:1894–1899PubMedCrossRef

28.

Misonoo G, Kanamori A, Ida H, Miyakawa S, Ochiai N (2012) Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity—A quasi-randomized trial. Knee 19:87–93PubMedCrossRef

29.

Moisala AS, Järvelä T, Harilainen A, Sandelin J, Kannus P, Järvinen M (2007) The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study. Knee Surg Sports Traumatol Arthrosc 15:879–887PubMedCrossRef

30.

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

31.

Peccin MS, Ciconelli R, Cohen M (2006) Specific questionnaire for knee symptoms—the “Lysholm Knee Scoring Scale”: translation and validation into Portuguese. Acta Ortop Bras [online] 14:268–272

32.

Pinczewski LA, Salmon LJ, Jackson WF, von Bormann RB, Haslam PG, Tashiro S (2008) Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 90:172–179PubMedCrossRef

33.

Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251PubMedCrossRef

34.

Sommer C, Friederich NF, Müller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8:207–213PubMedCrossRef

35.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed

36.

Topliss C, Webb J (2001) An audit of tunnel position in anterior cruciate ligament reconstruction. Knee 8:59–63PubMedCrossRef

37.

World Medical Association (2001) World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 79:373–374PubMedCentral

Title: The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports
Authors: Tiago Lazzaretti Fernandes
Felipe Fregni
Kayleen Weaver
André Pedrinelli
Gilberto Luis Camanho
Arnaldo José Hernandez
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2288-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2014

The prevention of injuries in contact flag football

Is there a role for adult non-cultivated bone marrow stem cells in ACL reconstruction?

Successful fixation of Mason type 2 radial head fractures using Meniscus Arrows

Prevention of anterior cruciate ligament injuries in sports—Part I: Systematic review of risk factors in male athletes

Comparison of Achilles and tibialis anterior tendon allografts after anterior cruciate ligament reconstruction

ACL surgery is not for all patients, nor for all surgeons