Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2019

01-08-2019 | KNEE

Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling—a 3D and finite element analysis

Authors: Thomas Tampere, Wouter Devriendt, Michiel Cromheecke, Thomas Luyckx, Matthias Verstraete, Jan Victor

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2019

Login to get access

Abstract

Purpose

Recent studies have emphasized the importance of anatomical ACL reconstruction to restore normal knee kinematics and stability. Aim of this study is to evaluate and compare the ability of the anteromedial (AM) and transtibial (TT) techniques for ACL reconstruction to achieve anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces within the graft during functional motion. As the AM technique is nowadays the technique of choice, the hypothesis is that there are significant differences in tunnel features, reaction forces and/or moments within the graft when compared to the TT technique.

Methods

Twenty ACL-deficient patients were allocated to reconstruction surgery with one of both techniques. Postoperatively, all patients underwent a computed tomography scan (CT) allowing 3D reconstruction to analyze tunnel geometry and tunnel placement within the native ACL footprint. A patient-specific finite element analysis (FEA) was conducted to determine reaction forces and moments within the graft during antero-posterior translation and pivot-shift motion.

Results

With significantly shorter femoral tunnels (p < 0.001) and a smaller inter-tunnel angle (p < 0.001), the AM technique places tunnels with less variance, close to the anatomical centre of the ACL footprints when compared to the TT technique. Using the latter, tibial tunnels were more medialised (p = 0.007) with a higher position of the femoral tunnels (p = 0.02). FEA showed the occurrence of higher, but non-significant, reaction forces in the graft, especially on the femoral side and lower, however, statistically not significant, reaction moments using the AM technique.

Conclusion

This study indicates important, technique-dependent differences in tunnel features with changes in reaction forces and moments within the graft.

Level of evidence

II.
Literature
1.
Aga C, Wilson K, Johansen S, Dornan G, La Prade R, Engebretsen L (2017) Tunnel widening in single- versus double-bundle anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc 25(4):1316–1327CrossRefPubMed
2.
Amis A, Jakob R (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6:S2–S12CrossRefPubMed
3.
Arno S et al (2016) Does anteromedial portal drilling improve footprint placement in anterior cruciate ligament reconstruction? Clin Orthop Relat Res 474(7):1679–1689CrossRefPubMedPubMedCentral
4.
Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–22PubMed
5.
Bischoff J (2008) Advanced material modeling in a virtual biomechanical knee. Abaqus Users’ conference. Newport, Rhode Island
6.
Bull A, Amis A (1998) The pivot-shift phenomenon: a clinical and biomechanical perspective. Knee 3(5):141–158CrossRef
7.
Clockaerts S, Van Haver A, Verhaeghen J, Vuylsteke K, Leenders T, Lagae KC, Verdonk P (2016) Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: a 3D CT imaging study. Knee 23(3):412–419CrossRefPubMed
8.
Desai N, Andernord D, Sundemo D, Alentorn-Geli E, Musahl V, Fu F, Forssblad M, Samuelsson K (2017) Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17.682 patients from the Swedish National knee ligament register. Knee Surg Sports Traumatol Arthrosc 25(5):1542–1554CrossRefPubMed
9.
Kaiser J, Vignos M, Kijowski R, Baer G, Thelen D (2017) Effect of loading on in vivo tibiofemoral and patellofemoral kinematics of healthy and ACL-reconstructed knees. Am J Sports Med 45(14):3272–3279CrossRefPubMedPubMedCentral
10.
Lubowitz JH et al (2014) Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 22(5):1190–1195CrossRefPubMed
11.
Mai H, Chun D, Schneider A, Erickson B, Freshman R, Kester B, Verma N, Hsu W (2017) Performance-based outcomes after anterior cruciate ligament reconstruction in professional athletes differ between sports. Am J Sports Med 45(10):2226–2232CrossRefPubMed
12.
Marumo K, Saito M, Yamagishi T (2005) The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons. Am J Sports Med 33:1166–1173CrossRefPubMed
13.
Nawabi D, Tucker S, Schafer K, Zuiderbaan H, Nguyen J, Wickiewicz T, Imhauser C, Pearle A (2016) ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med 44(10):2563–2571CrossRefPubMed
14.
Osti M, Krawinkel A, Ostermann M, hoffelner T, Benedetto K (2015) Femoral and tibial graft tunnel parameters after transtibial, anteromedial portal, and outside-in single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 43(9):2250–2258CrossRefPubMed
15.
Parkar AP, Adriaensen M, Vindfeld S, Solheim E (2017) The anatomic centers of the femoral and tibial insertions of the anterior cruciate ligament. Am J Sports Med 45(9):2180–2188CrossRefPubMed
16.
Rahr-Wagner L, Thillemann T, Pedersen A, Lind M (2013) Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish knee ligament reconstruction register. Arthroscopy 29(1):98–105CrossRefPubMed
17.
Riboh J, Hasselblad V, Godin J, Mather R (2013) Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis and meta-regression. Am J Sports Med 41(11):2693–2702CrossRefPubMed
18.
Robin B, Jani S, Marvil S, Reid J, Schillhammer C, Lubowitz J (2015) Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction. Arthroscopy 31(7):1412–1417CrossRefPubMed
19.
Sepúlveda F, Sánchez L, Amy E, Micheo W (2017) Anterior cruciate ligament injury: return to play, function and long-term considerations. Curr Sports Med Rep 16(3):172–178CrossRefPubMed
20.
Siebold R, Ellert T, Metz S, Metz J (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Arthroscopy 24(5):585–592CrossRefPubMed
21.
Tampere T, Van Hoof T, Cromheecke M, Van der Bracht H, Chahla J, Verdonk P, Victor J (2017) The anterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology. Knee Surg Sports Traumatol Arthrosc 25(1):236–244CrossRefPubMed
22.
Wang H, Fleischli J, Hutchinson I, Zheng N (2014) Knee moment and shear force are correlated with femoral tunnel orientation after single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 42(10):2377–2385CrossRefPubMed
23.
Wang J, Kim J, Lee do K, Lim H, Ahn J (2012) Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(8):1584–1593CrossRefPubMed
24.
Xie F, Yang L, Guo L, Wang Z, Dai G (2009) A study on construction three-dimensional nonlinear finite element model and stress distribution analysis of anterior cruciate ligament. J Biomech Eng 131(12):1210CrossRef
25.
Xu Y, Liu J, Kramer S et al (2011) comparison of in situ forces and knee kinematics in anteromedial and high anteromedial bundle augmentation for partially ruptured anterior cruciate ligament. Am J Sports Med 39(2):272–278CrossRefPubMed
Metadata
Title
Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling—a 3D and finite element analysis
Authors
Thomas Tampere
Wouter Devriendt
Michiel Cromheecke
Thomas Luyckx
Matthias Verstraete
Jan Victor
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5272-0

Other articles of this Issue 8/2019

Knee Surgery, Sports Traumatology, Arthroscopy 8/2019 Go to the issue

Correction

Correction to: Meniscal extrusion is positively correlated with the anatomical position changes of the meniscal anterior and posterior horns, following medial meniscal allograft transplantation

KNEE

The detached stump of the torn anterior cruciate ligament adheres to the femoral notch wall and then to the posterior cruciate ligament within 6 months from injury

KNEE

Mountain ultramarathon results in temporary meniscus extrusion in healthy athletes

KNEE

Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction

KNEE

Bone block augmentation from the iliac crest for treatment of deep osteochondral defects of the knee resembles biomechanical properties of the subchondral bone

KNEE

Low rate of return to pre-injury sport level in athletes after cartilage surgery: a 10-year follow-up study