Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-09-2014 | Knee

Clinical outcome of anatomic double-bundle ACL reconstruction and 3D CT model-based validation of femoral socket aperture position

Authors: Shuji Taketomi, Hiroshi Inui, Kensuke Nakamura, Jinso Hirota, Takaki Sanada, Hironari Masuda, Hideki Takeda, Sakae Tanaka, Takumi Nakagawa

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2014

Abstract

Purpose

The purpose of this study was to evaluate the clinical results of anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction in which anatomic position of femoral socket apertures was validated using three-dimensional (3D) computed tomography (CT) modelling.

Methods

Anatomic DB ACL reconstructions with hamstring autografts were performed in 34 patients. Two femoral sockets were created through a far anteromedial (AM) portal behind the lateral intercondylar ridge with the assistance of intraoperative 3D fluoroscopic navigation. Femoral tunnel aperture positioning was investigated postoperatively using 3D CT images in all patients. Clinical results were also evaluated subjectively and objectively at least up to 2 years.

Results

Measurement of the AM and the posterolateral (PL) femoral socket locations on the 3D CT images using the quadrant method showed that the centre of the AM socket aperture was located at a depth of 21.0 ± 4.1 % and a height of 30.5 ± 9.3 % and that of the PL socket aperture was located at a depth of 31.3 ± 5.8 % and a height of 57.2 ± 7.7 %. The femoral socket locations were considered as anatomic in accordance with previous cadaveric studies examining the positions of ACL femoral insertion site. Subjectively, the mean Lysholm score was 96.9 ± 4.0 points. According to IKDC final objective scores, 26 knees (76 %) were objectively graded as normal, 8 (24 %) as nearly normal, and 0 (0 %) as abnormal or severely abnormal. Postoperative side-to-side anterior translation measured with a KT-2000 arthrometer averaged 0.7 ± 1.2 mm.

Conclusions

DB ACL reconstructions in which femoral socket apertures were validated anatomically using 3D CT provided satisfactory short-term results.

Level of evidence

Case series, Level IV.

Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113PubMedCrossRef

Amis A, Dawkins G (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267PubMed

Arnoczky S (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 172:19–25PubMed

Basdekis G, Christel P, Anne F (2009) Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan. Knee Surg Sports Traumatol Arthrosc 17:1089–1094PubMedCrossRef

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

Bird JH, Carmont MR, Dhillon M, Smith N, Brown C, Thompson P, Spalding T (2011) Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 27:1259–1267PubMedCrossRef

Colombet P, Robinson J (2008) Computer-assisted, anatomic, double-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:1152–1160PubMedCrossRef

Colombet P, Robinson J, Christel P, Franceschi J, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRef

Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH (2012) Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Knee Surg Sports Traumatol Arthrosc 20:62–68PubMedCrossRef

10.

Ferretti M, Ekdahl M, Shen W, Fu F (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRef

11.

Forsythe B, Kopf S, Wong A, Martins C, Anderst W, Tashman S, Fu F (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

12.

Fu F, Jordan S (2007) The lateral intercondylar ridge—a key to anatomic anterior cruciate ligament reconstruction. J Bone Joint Surg Am 89:2103–2104PubMedCrossRef

13.

Galway H, MacIntosh D (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50PubMed

14.

Giron F, Cuomo P, Aglietti P, Bull A, Amis A (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256PubMedCrossRef

15.

Hoser C, Tecklenburg K, Kuenzel KH, Fink C (2005) Postoperative evaluation of femoral tunnel position in ACL reconstruction: plain radiography versus computed tomography. Knee Surg Sports Traumatol Arthrosc 13:256–262PubMedCrossRef

16.

Iriuchishima T, Ingham SJ, Tajima G, Horaguchi T, Saito A, Tokuhashi Y, Van Houten AH, Aerts MM, Fu FH (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231PubMedCrossRef

17.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P, Richmond J, Shelborne K (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMed

18.

Kawakami Y, Hiranaka T, Matsumoto T, Hida Y, Fukui T, Uemoto H, Doita M, Tsuji M, Kurosaka M, Kuroda R (2012) The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1503–1510PubMedCrossRef

19.

Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687PubMedCrossRef

20.

Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20:2200–2207PubMedCentralPubMedCrossRef

21.

Lee YS, Sim JA, Kwak JH, Nam SW, Kim KH, Lee BK (2012) Comparative analysis of femoral tunnels between outside-in and transtibial double-bundle anterior cruciate ligament reconstruction: a 3-dimensional computed tomography study. Arthroscopy 28:1417–1423PubMedCrossRef

22.

Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27:391–398PubMedCrossRef

23.

Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef

24.

Muneta T, Koga H, Mochizuki T, Ju Y, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628PubMedCrossRef

25.

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

26.

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 24:1161–1167PubMedCrossRef

27.

Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240PubMedCrossRef

28.

Papannagari R, Gill T, Defrate L, Moses J, Petruska A, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012PubMedCrossRef

29.

Sadoghi P, Kropfl A, Jansson V, Muller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27:355–364PubMedCrossRef

30.

Shino K, Horibe S, Hamada M, Nakamura N, Nakata K, Toritsuka Y, Mae T (2002) Allograft anterior cruciate ligament reconstruction. Tech Knee Surg 1:78–85CrossRef

31.

Shino K, Suzuki T, Iwahashi T, Mae T, Nakamura N, Nakata K, Nakagawa S (2010) The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1164–1168PubMedCrossRef

32.

Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145PubMedCrossRef

33.

Taketomi S, Inui H, Nakamura K, Hirota J, Takei S, Takeda H, Tanaka S, Nakagawa T (2012) Three-dimensional fluoroscopic navigation guidance for femoral tunnel creation in revision anterior cruciate ligament reconstruction. Arthrosc Tech 1:e95–e99PubMedCentralPubMedCrossRef

34.

Taketomi S, Nakagawa T, Takeda H, Nakajima K, Nakayama S, Fukai A, Hirota J, Kachi Y, Kawano H, Miura T, Fukui N, Nakamura K (2011) Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first? Knee Surg Sports Traumatol Arthrosc 19:424–431PubMedCrossRef

35.

Tashiro Y, Okazaki K, Miura H, Matsuda S, Yasunaga T, Hashizume M, Nakanishi Y, Iwamoto Y (2009) Quantitative assessment of rotatory instability after anterior cruciate ligament reconstruction. Am J Sports Med 37:909–916PubMedCrossRef

36.

Tensho K, Kodaira H, Yasuda G, Yoshimura Y, Narita N, Morioka S, Kato H, Saito N (2011) Anatomic double-bundle anterior cruciate ligament reconstruction, using CT-based navigation and fiducial markers. Knee Surg Sports Traumatol Arthrosc 19:378–383PubMedCrossRef

37.

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 17:456–463PubMedCrossRef

38.

Tsuda E, Ishibashi Y, Fukuda A, Yamamoto Y, Tsukada H, Ono S (2010) Tunnel position and relationship to postoperative knee laxity after double-bundle anterior cruciate ligament reconstruction with a transtibial technique. Am J Sports Med 38:698–706PubMedCrossRef

39.

van Eck CF, Morse KR, Lesniak BP, Kropf EJ, Tranovich MJ, van Dijk CN, Fu FH (2010) Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc 18:1184–1188PubMedCentralPubMedCrossRef

40.

van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–12PubMedCrossRef

41.

Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107PubMedCrossRef

42.

Zantop T, Diermann N, Schumacher T, Schanz S, Fu F, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMedCrossRef

43.

Zantop T, Wellmann M, Fu F, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef

44.

Zhao J, Peng X, He Y, Wang J (2006) Two-bundle anterior cruciate ligament reconstruction with eight-stranded hamstring tendons: four-tunnel technique. Knee 13:36–41PubMedCrossRef

Title: Clinical outcome of anatomic double-bundle ACL reconstruction and 3D CT model-based validation of femoral socket aperture position
Authors: Shuji Taketomi
Hiroshi Inui
Kensuke Nakamura
Jinso Hirota
Takaki Sanada
Hironari Masuda
Hideki Takeda
Sakae Tanaka
Takumi Nakagawa
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2663-0

At a glance: The STEP trials

Springer Medicine

Clinical outcome of anatomic double-bundle ACL reconstruction and 3D CT model-based validation of femoral socket aperture position

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 9/2014

Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft

Biomechanical properties of femoral posterior cruciate ligament fixations

The effect of infraspinatus hypotrophy and weakness on the arthroscopic treatment of spinoglenoid notch cyst associated with superior labrum anterior-to-posterior lesions

Comparison of double-bundle anterior cruciate ligament (ACL) reconstruction and single-bundle reconstruction with remnant pull-out suture

Long-term results of a randomized study on anterior cruciate ligament reconstruction with or without a synthetic degradable augmentation device to support the autograft

Maqdes A, Levy B, Klouche S, Hardy P: The feasibility and results of an arthroscopic removal of humeral locking plates and glenohumeral arthrolysis after proximal humeral fractures. Knee Surg Sports Traumatol Arthrosc 2013 Feb 9. [Epub ahead of print] Doi 10.1007/s00167-013-2437-8