Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 6/2013

01-06-2013 | Arthroscopy and Sports Medicine

Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers

Authors: Wolf Petersen, Philipp Forkel, Andrea Achtnich, Sebastian Metzlaff, Thore Zantop

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2013

Login to get access

Abstract

Purpose

The purpose of this article was to demonstrate an anterior cruciate ligament (ACL) reconstruction technique using oval tunnels. Aim of this single bundle technique is to fit the footprint anatomy of the ACL as closely as possible.

Technique and patients

The presented technique is a single bundle technique using a semitendinosus graft. For femoral tunnel placement, a specific medial portal aimer (Karl Storz, Tuttlingen, Germany) is used. Aiming and drilling of the femoral tunnel are performed via the medial portal. Oval tunnels are created by stepwise dilatation with ovally shaped dilatators. The position of the femoral tunnel is visualized and controlled with the arthroscope via the medial portal. For the tibial tunnel placement, a specific aimer was used as well. With this technique, 24 patients were operated and all intra- and postoperative complications were analyzed prospectively. The tunnel position was documented postoperatively by CT scan.

Results

There were no significant intra- and postoperative complications associated with the oval tunnel technique. The postoperative 3D CT scan revealed that all femoral and tibial tunnels were located within the area of the anatomical ACL insertions.

Conclusions

This article presents an ACL reconstruction technique using oval dilatators and medial portal aimers to create oval tunnels. These oval tunnels match the insertion site anatomy much closer than round tunnels do.

Level of Evidence

Level IV, case series.
Literature
1.
go back to reference Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N (2010) Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38(1):25–34PubMedCrossRef Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N (2010) Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38(1):25–34PubMedCrossRef
2.
go back to reference Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279PubMed Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279PubMed
3.
go back to reference Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Fourstrand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728PubMed Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Fourstrand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728PubMed
4.
go back to reference Barrett GR, Noojin FK, Hartzog CW, Nash CR (2002) Reconstructionof the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 18:46–54PubMed Barrett GR, Noojin FK, Hartzog CW, Nash CR (2002) Reconstructionof the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 18:46–54PubMed
5.
go back to reference Battaglia TC, Miller MD (2005) Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique. Arthroscopy 21(6):767PubMed Battaglia TC, Miller MD (2005) Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique. Arthroscopy 21(6):767PubMed
6.
go back to reference Bedi A, Altchek DW (2009) The “footprint” anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 25(10):1128–1138PubMedCrossRef Bedi A, Altchek DW (2009) The “footprint” anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 25(10):1128–1138PubMedCrossRef
7.
go back to reference Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27(3):380–390PubMedCrossRef Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27(3):380–390PubMedCrossRef
8.
go back to reference Behrendt S, Richter J (2010) Anterior cruciate ligament reconstruction: drilling a femoral posterolateral tunnel cannot be accomplished using an over-the-top step-off drill guide. Knee Surg Sports Traumatol Arthrosc 18(9):1252–1256PubMedCrossRef Behrendt S, Richter J (2010) Anterior cruciate ligament reconstruction: drilling a femoral posterolateral tunnel cannot be accomplished using an over-the-top step-off drill guide. Knee Surg Sports Traumatol Arthrosc 18(9):1252–1256PubMedCrossRef
9.
go back to reference Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27(11):1511–1522PubMedCrossRef Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27(11):1511–1522PubMedCrossRef
10.
11.
go back to reference Herbort M, Lenschow S, Fu FH, Petersen W, Zantop T (2010) ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18(11):1551–1558PubMedCrossRef Herbort M, Lenschow S, Fu FH, Petersen W, Zantop T (2010) ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18(11):1551–1558PubMedCrossRef
12.
go back to reference Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25(5):464–472PubMedCrossRef Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25(5):464–472PubMedCrossRef
13.
go back to reference Kato Y, Maeyama A, Lertwanich P, Wang JH, Ingham SJ, Kramer S, Martins CQ, Smolinski P, Fu FH (2013) Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(4):816-823 Kato Y, Maeyama A, Lertwanich P, Wang JH, Ingham SJ, Kramer S, Martins CQ, Smolinski P, Fu FH (2013) Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(4):816-823
14.
go back to reference Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy19:297–304 Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy19:297–304
15.
go back to reference Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101PubMedCrossRef Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101PubMedCrossRef
16.
go back to reference Muneta T, Koga H, Mochizuki T, Ju YJ, 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(6):618–628PubMedCrossRef Muneta T, Koga H, Mochizuki T, Ju YJ, 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(6):618–628PubMedCrossRef
17.
go back to reference Pascual-Garrido C, Swanson BL, Swanson KE (2012) Transtibial versus low anteromedial portal drilling for anterior cruciate ligament reconstruction: a radiographic study of femoral tunnel position. Knee Surg Sports Traumatol Arthrosc 21(4):846-850 Pascual-Garrido C, Swanson BL, Swanson KE (2012) Transtibial versus low anteromedial portal drilling for anterior cruciate ligament reconstruction: a radiographic study of femoral tunnel position. Knee Surg Sports Traumatol Arthrosc 21(4):846-850
18.
go back to reference Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47PubMedCrossRef Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47PubMedCrossRef
19.
go back to reference Sastre S, Popescu D, Núñez M, Pomes J, Tomas X, Peidro L (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18(1):32–36PubMedCrossRef Sastre S, Popescu D, Núñez M, Pomes J, Tomas X, Peidro L (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18(1):32–36PubMedCrossRef
20.
go back to reference Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16(3):232–238PubMedCrossRef Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16(3):232–238PubMedCrossRef
21.
go back to reference Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23(3):291–298PubMedCrossRef Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23(3):291–298PubMedCrossRef
22.
go back to reference Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17(3):211–212PubMedCrossRef Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17(3):211–212PubMedCrossRef
23.
go back to reference Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussière C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19(2):196–201PubMedCrossRef Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussière C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P (2011) Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 19(2):196–201PubMedCrossRef
24.
go back to reference Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–112PubMedCrossRef Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–112PubMedCrossRef
25.
go back to reference Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22(3):240–251PubMedCrossRef Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22(3):240–251PubMedCrossRef
26.
go back to reference Zantop T, Petersen W (2011) Arthroscopic filling of misplaced and wide bone tunnels after reconstruction of the anterior cruciate ligament with bone graft in patients with recurrent instability. Oper Orthop Traumatol 23(4):337-350 Zantop T, Petersen W (2011) Arthroscopic filling of misplaced and wide bone tunnels after reconstruction of the anterior cruciate ligament with bone graft in patients with recurrent instability. Oper Orthop Traumatol 23(4):337-350
27.
go back to reference Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35(2):223–227PubMedCrossRef Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35(2):223–227PubMedCrossRef
28.
go back to reference Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14(10):982–992PubMedCrossRef Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14(10):982–992PubMedCrossRef
Metadata
Title
Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers
Authors
Wolf Petersen
Philipp Forkel
Andrea Achtnich
Sebastian Metzlaff
Thore Zantop
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 6/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1741-6

Other articles of this Issue 6/2013

Archives of Orthopaedic and Trauma Surgery 6/2013 Go to the issue