Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2012 | Knee

The effects of limb alignment on anterior cruciate ligament graft tunnel positions estimated from plain radiographs

Authors: Carola F. van Eck, Andrew K. Wong, J. J. Irrgang, Freddie H. Fu, Scott Tashman

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2012

Abstract

Purpose

The aims of this study were (1) to evaluate the femoral tunnel position after anatomic double-bundle and nonanatomic single-bundle reconstruction; (2) to evaluate the influence of rotation of the femur caused by limb malalignment on measurements of the position of the femoral ACL tunnel aperture relative to Blumensaat’s line.

Methods

3D CT scans were performed in 5 patients after anatomic double-bundle reconstruction and 5 patients after nonanatomic single-bundle reconstruction. Digitally reconstructed lateral radiographs were generated from the 3D CT scans to determine the tunnel position on the femur along and perpendicular to Blumensaat’s line. The femur was then rotated to simulate internal/external and varus/valgus rotations from 0° to 15° in 5° increments. At each rotated bone position, tunnel position relative to Blumensaat’s line was calculated and the difference from the lateral radiograph was calculated.

Results

After double-bundle reconstruction, the AM tunnel was located at 31.5 (±5.0) % along Blumensaat’s line and 29.7 (±13.6) % perpendicular to Blumensaat’s line, and the PL tunnel at 36.2 (±12.9) % along Blumensaat’s line and 34.2 (±7.6) % perpendicular to Blumensaat’s line. Valgus greater than 10° significantly affected the assessment of tunnel position (P = 0.043). After nonanatomic single-bundle reconstruction, the tunnel position was 35.4 (±15.0) % along Blumensaat’s line and −2.7 (±19.4) % perpendicular to Blumensaat’s line. Internal rotation of more than 10° significantly affected the assessment of tunnel position (P = 0.043).

Conclusions

Tunnel position after anatomic double-bundle reconstruction and nonanatomic single-bundle reconstruction can be determined on lateral radiographs. However, valgus and internal rotation of more than 10° can introduce significant errors in tunnel position estimates.

Level of evidence

Case series, Level IV.

Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R et al (1994) Proceedings of the ESSKA scientific workshop on reconstruction of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 2:124–132PubMedCrossRef

Anderst W, Zauel R, Bishop J, Demps E, Tashman S (2009) Validation of three-dimensional model-based tibio-femoral tracking during running. Med Eng Phys 31:10–16PubMedCrossRef

Bedi A, Maak T, Musahl V, O’Loughlin P, Choi D, Citak M, Pearle AD (2011) Effect of tunnel position and graft size in single-bundle anterior cruciate ligament reconstruction: an evaluation of time-zero knee stability arthroscopy. doi:10.1016/j.arthro.2011.03.079

Behrend H, Stutz G, Kessler MA, Rukavina A, Giesinger K, Kuster MS (2006) Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital. Knee Surg Sports Traumatol Arthrosc 14:1159–1165PubMedCrossRef

Bernard M, Hertel P (1996) Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty. A radiologic measuring method (quadrant method). Unfallchirurg 99:332–340PubMed

Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21 (discussion 21-12)PubMed

Bird JH, Carmont MR, Dhillon M, Smith N, Brown C, Thompson P, Spalding T (2011) Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 27:1259–1267PubMedCrossRef

Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23:e321–e325

Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRef

10.

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 16:29–36PubMedCrossRef

11.

Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRef

12.

Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426PubMedCrossRef

13.

George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037PubMedCrossRef

14.

Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431PubMedCrossRef

15.

Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH (2010) Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med 39:108–113PubMedCrossRef

16.

Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability, graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock, 10 o’clock femoral tunnel placement. Richard O’Connor Award paper. Arthroscopy 19:297–304PubMedCrossRef

17.

Markolf KL, Hame S, Hunter DM, Oakes DA, Zoric B, Gause P, Finerman GA (2002) Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. J Orthop Res 20:1016–1024PubMedCrossRef

18.

Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718PubMedCrossRef

19.

Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293PubMedCrossRef

20.

Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg Am 85-A:1018–1029PubMed

21.

Topliss C, Webb J (2001) An audit of tunnel position in anterior cruciate ligament reconstruction. Knee 8:59–63PubMedCrossRef

22.

van Eck CF, Martins CA, Vyas SM, Celentano U, van Dijk CN, Fu FH (2010) Femoral intercondylar notch shape and dimensions in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 18:1257–1262PubMedCrossRef

23.

van Eck CF, Morse KR, Lesniak BP, Kropf EJ, Tranovich MJ, van Dijk CN, Fu FH (2011) Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc 18:1184–1188CrossRef

24.

Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef

25.

Zelle BA, Brucker PU, Feng MT, Fu FH (2006) Anatomical double-bundle anterior cruciate ligament reconstruction. Sports Med 36:99–108PubMedCrossRef

Title: The effects of limb alignment on anterior cruciate ligament graft tunnel positions estimated from plain radiographs
Authors: Carola F. van Eck
Andrew K. Wong
J. J. Irrgang
Freddie H. Fu
Scott Tashman
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1683-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effects of limb alignment on anterior cruciate ligament graft tunnel positions estimated from plain radiographs

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 5/2012

Rollback of the femoral condyle in anatomical double-bundle anterior cruciate ligament reconstruction

Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy

ACL reconstruction: comparison between transtibial and anteromedial portal techniques

PCL to graft impingement pressure after anatomical or non-anatomical single-bundle ACL reconstruction

Measuring the anterior cruciate ligament’s footprints by three-dimensional magnetic resonance imaging

Static rotational and sagittal knee laxity measurements after reconstruction of the anterior cruciate ligament