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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2015

01-08-2015 | Knee

Is the native ACL insertion site “completely restored” using an individualized approach to single-bundle ACL-R?

Authors: K. K. Middleton, B. Muller, P. H. Araujo, Y. Fujimaki, S. J. Rabuck, J. J. Irrgang, S. Tashman, F. H. Fu

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2015

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Abstract

Purpose

The goal of individualized anatomic anterior cruciate ligament reconstruction (ACL-R) is to reproduce each patient’s native insertion site as closely as possible. The amount of the native insertion site that is recreated by the tunnel aperture area is currently unknown, as are the implications of the degree of coverage. As such, the goals of this study are to determine whether individualized anatomic ACL-R techniques can maximally fill the native insertion site and to attempt to establish a crude measure to evaluate the percentage of reconstructed area as a first step towards elucidating the implications of complete footprint restoration.

Methods

This is a prospective pilot study of 45 patients who underwent primary single-bundle anatomic ACL-R from May 2011 to April 2012. Length and width of the native insertion site were measured intraoperatively. Using published guidelines, reconstruction technique and graft choice were determined to maximize the percentage of reconstructed area. Native femoral and tibial insertion site area and femoral tunnel aperture area were calculated using the formula for area of an ellipse. On the tibial side, tunnel aperture area was calculated with respect to drill diameter and drill guide angle. Percentage of reconstructed area was calculated by dividing total tunnel aperture area by the native insertion site area.

Results

The mean areas for the native femoral and tibial insertion sites were 83 ± 20 and 125 ± 20 mm2, respectively. The mean tunnel aperture area for the femoral side was 65 ± 17, and 86 ± 17 mm2 for the tibial tunnel aperture area. On average, percentage of reconstructed area was 79 ± 13 % for the femoral side, and 70 ± 12 % for the tibial side.

Conclusion

Anatomic ACL-R does not restore the native insertion site in its entirety. Percentage of reconstructed area serves as a rudimentary tool for evaluating the degree of native insertion site coverage using current individualized anatomic techniques and provides a starting point from which to evaluate the clinical significance of complete footprint restoration.

Level of evidence

IV.
Literature
1.
Auge WK II, Yifan K (1999) A technique for resolution of graft-tunnel length mismatch in central third bone-patellar tendon-bone anterior cruciate ligament reconstruction. Arthroscopy 15(8):877–881PubMedCrossRef
2.
Bedi A, Maak T, Musahl V, Citak M, O’Loughlin PF, Choi D, Pearle AD (2011) Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important? Am J Sports Med 39(2):366–373PubMedCrossRef
3.
Clancy WG Jr, Narechania RG, Rosenberg TD, Gmeiner JG, Wisnefske DD, Lange TA (1981) Anterior and posterior cruciate ligament reconstruction in rhesus monkeys. J Bone Joint Surg Am 63(8):1270–1284PubMed
4.
Debandi A, Maeyama A, Hoshino Y, Asai S, Goto B, Smolinski P, Fu FH (2012) The effect of tunnel placement on rotational stability after ACL reconstruction: evaluation with use of triaxial accelerometry in a porcine model. Knee Surg Sports Traumatol Arthrosc 21(3):589–595PubMedCrossRef
5.
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(12):1414–1421PubMedCrossRef
6.
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(1):29–36PubMedCrossRef
7.
Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ (1992) The correlation between anterior–posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res 10(6):878–885PubMedCrossRef
8.
Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15(7):741–749PubMedCrossRef
9.
Hensler D, Working ZM, Illingworth KD, Thorhauer ED, Tashman S, Fu FH (2011) Medial portal drilling: effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 93(22):2063–2071PubMedCrossRef
10.
Hofbauer M, Muller B, Murawski CD, van Eck CF, Fu FH (2013) The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2562-4
11.
Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40(8):1781–1788PubMedCrossRef
12.
Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40(8):1781–1788PubMedCrossRef
13.
Iriuchishima T, Yorifuji H, Aizawa S, Tajika Y, Murakami T, Fu FH (2012) Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection. Knee Surg Sports Traumatol Arthrosc 22(1):207–213PubMedCrossRef
14.
Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR (2013) Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 41(8):1808–1812PubMedCrossRef
15.
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(9):2016–2026PubMedCrossRef
16.
Kopf S, Martin DE, Tashman S, Fu FH (2010) Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92(4):871–881PubMedCrossRef
17.
Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH (2011) Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med 39(1):108–113PubMedCrossRef
18.
Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE (2012) Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy 28(4):526–531PubMedCrossRef
19.
Noyes FR, Butler DL, Paulos LE, Grood ES (1983) Intra-articular cruciate reconstruction. I: perspectives on graft strength, vascularization, and immediate motion after replacement. Clin Orthop Relat Res 172:71–77PubMed
20.
Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH (2012) Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1111–1118PubMedCrossRef
21.
Rabuck SJ, Middleton KK, Maeda S, Fujimaki Y, Muller B, Araujo PH, Fu FH (2012) Individualized anatomic anterior cruciate ligament reconstruction. Arthrosc Tech 1(1):e23–e29PubMedCentralPubMedCrossRef
22.
Shino K, Kawasaki T, Hirose H, Gotoh I, Inoue M, Ono K (1984) Replacement of the anterior cruciate ligament by an allogeneic tendon graft. An experimental study in the dog. J Bone Joint Surg Br 66(5):672–681PubMed
23.
Siebold R (2011) The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19(5):699–706PubMedCrossRef
24.
Tashman S, Kopf S, Fu FH (2008) The kinematic basis of ACL reconstruction. Op Tech Sports Med 16(3):116–118CrossRef
25.
Van der Bracht H, Bellemans J, Victor J, Verhelst L, Page B, Verdonk P (2013) Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis. Knee Surg Sports Traumatol Arthrosc 22(2):291–297PubMedCrossRef
26.
van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26(2):258–268PubMedCrossRef
27.
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):1282–1289PubMedCrossRef
28.
Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, 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(4):678–685PubMedCrossRef
Metadata
Title
Is the native ACL insertion site “completely restored” using an individualized approach to single-bundle ACL-R?
Authors
K. K. Middleton
B. Muller
P. H. Araujo
Y. Fujimaki
S. J. Rabuck
J. J. Irrgang
S. Tashman
F. H. Fu
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3043-0

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