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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2016

01-09-2016 | Knee

Optimal entry position on the lateral femoral surface for outside-in drilling technique to restore the anatomical footprint of anterior cruciate ligament

Authors: Hirokazu Matsubara, Ken Okazaki, Kanji Osaki, Yasutaka Tashiro, Hideki Mizu-uchi, Satoshi Hamai, Yukihide Iwamoto

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2016

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Abstract

Purpose

To investigate the optimal starting points for drilling on the lateral femoral condyle for better coverage of the anatomical footprint of the anterior cruciate ligament (ACL) using the outside-in (OI) technique in a single-bundle ACL reconstruction.

Methods

Femoral tunnel drilling was simulated on three-dimensional bone models from 40 subjects by connecting the centre of the ACL footprint with various points on the lateral femoral surface. The percentage of the femoral footprint covered by apertures of the virtual tunnel sockets with 9 mm diameter was calculated for each tunnel.

Results

The mean percentages of the femoral footprint covered by the apertures of the virtual tunnel sockets were significantly higher when drilled at 2 and 3 cm from the lateral epicondyle on a 45° line and a 60° line anterior from the proximal–distal axis than the other points. However, articular cartilage damage was occurred in nine subjects at 3 cm on a 60° line and eight subjects at 3 cm on a 45° line. Posterior wall blowout occurred in five subjects at 3 cm on a 45° line. Thus, OI drilling at 3 cm from the epicondyle has a risk of these complications.

Conclusion

During the OI drilling of the femoral tunnel, connecting the centre of the anatomical footprint of the ACL and the entry drilling point at 2 cm from the lateral epicondyle on between the 45° line and the 60° line anterior from the proximal–distal axis provides an oval-shaped socket aperture that covers and restores the native ACL footprint as nearly as possible.

Level of evidence

III.
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Metadata
Title
Optimal entry position on the lateral femoral surface for outside-in drilling technique to restore the anatomical footprint of anterior cruciate ligament
Authors
Hirokazu Matsubara
Ken Okazaki
Kanji Osaki
Yasutaka Tashiro
Hideki Mizu-uchi
Satoshi Hamai
Yukihide Iwamoto
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3460-0

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