Top

Current Reviews in Musculoskeletal Medicine

Published in:

01-06-2011

Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique

Authors: Antonio Pastrone, Andrea Ferro, Matteo Bruzzone, Davide E. Bonasia, Pietro Pellegrino, Davide D’Elicio, Umberto Cottino, Roberto Rossi

Published in: Current Reviews in Musculoskeletal Medicine | Issue 2/2011

Abstract

The anterior cruciate ligament reconstruction is a common procedure that improves stability and function of the knee. The surgical technique continues to evolve and many issues are still under debate. These mainly include: (1) graft selection (patellar tendon, hamstring, quadriceps tendon, or allografts), (2) surgical technique (double versus single bundle), and (3) femoral tunnel drilling. Currently, the most controversial one is the femoral tunnel drilling (transtibial vs. anteromedial portal drilling). Common opinion is that drilling the femoral tunnel through the anteromedial (AM) allows a more anatomic placement of the graft and a better rotational stability; therefore, this technique is gaining in popularity compared with the transtibial drilling despite a greater difficulty and the risk of medial condyle damage, tunnel back wall blowout, and inadequate socket length. The aim of this article is to describe the surgical technique of the anterior cruciate ligament reconstruction (single and double bundle), drilling the femoral tunnel through the AM portal.

Brown CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999;18:109–11.PubMedCrossRef

Asano H, Muneta T, Ikeda H, et al. Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients. Arthroscopy. 2004;20(5):474–81.PubMedCrossRef

Gaudot F, Leymarie J-B, Drain O, Boisrenoult P, Charrois O, Beaufils P. Double-incision mini-invasive technique for BTB harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Orthop Traumatol Surg Res. 2009;95(1):28–35.PubMedCrossRef

Marcacci M, Paladini Molgora A, Zaffagnini S, et al. Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy. 2003;19(5):540–6.PubMedCrossRef

Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24(1):113–5.PubMedCrossRef

••Lubowitz JH, Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy. 2009 Jan;25(1):95–101. This study describes important pearls of the surgical technique. PubMedCrossRef

Asagumo H, Kimura M, Kobayashi Y, et al. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy. 2007;23(6):602–9.PubMedCrossRef

•Van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH. “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy. 2010 Sep;26(9 Suppl):S2-12. This study is the only systematic review that evaluate the studies published on ACL reconstruction. PubMed

Miller CD, Gerdeman AC, Bennett CG. A biomechanical comparison of the EndoButton CL using transtibial drilling and EndoButton direct using anteromedial arthroscopic drilling. Arthroscopy. 2010;26(10):1311–7.PubMedCrossRef

10.

Fu FH, Ranawat AS. Tensioning in double-bundle ACL reconstruction. Arthroscopy. 2007;23(9):1027.PubMedCrossRef

11.

Bedi A, Musahl V, O'Loughlin P, Maak T, Citak M, Dixon P, et al. A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics. Am J Sports Med. 2010;38(9):1788–94.PubMedCrossRef

12.

Markolf KL, Park S, Jackson SR, McAllister DR. Simulated pivot-shift testing with single and doublebundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am. 2008;90(8):1681–9.PubMedCrossRef

13.

Bedi A, Raphael B, Maderazo A, Pavlov H, Williams 3rd RJ. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy. 2010;26(3):342–50.PubMedCrossRef

14.

Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD. The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy. 2007;23:1187–92.PubMedCrossRef

15.

Scopp JM, Jasper LE, Belkoff SM, Moorman III CT. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy. 2004;20:294–9.PubMedCrossRef

16.

Musahl V, Plakseychuk A, VanScyoc A, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament reconstructed knee. Am J Sports Med. 2005;33:712–8.PubMedCrossRef

Title: Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique
Authors: Antonio Pastrone
Andrea Ferro
Matteo Bruzzone
Davide E. Bonasia
Pietro Pellegrino
Davide D’Elicio
Umberto Cottino
Roberto Rossi
Publication date: 01-06-2011
Publisher: Current Science Inc.
Published in: Current Reviews in Musculoskeletal Medicine / Issue 2/2011
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-011-9078-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2011

What’s new on ACL surgery horizon?

Anatomic double-bundle anterior crucial ligament reconstruction with G-ST

Pediatric anterior cruciate ligament reconstruction

Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review

Anatomical single bundle anterior cruciate ligament reconstruction