Effect of Femoral Tunnel Position on Graft Tension Curves and Knee Stability in Anatomic Double-bundle Anterior Cruciate Ligament Reconstruction

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Sep 25

PMID 24061720

Citations 13

Authors

Hideyuki Koga

Takeshi Muneta

Kazuyoshi Yagishita

Toshifumi Watanabe

Tomoyuki Mochizuki

Masafumi Horie

Tomomasa Nakamura

Ichiro Sekiya

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the effect of the femoral tunnel position of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) on the graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.

Methods: Forty-five patients who underwent anatomic double-bundle ACL reconstruction were included. AMB and PLB were provisionally fixed to a graft tensioning system in the following settings during surgery: (1) AMB at 20° and PLB at 0° (A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45° (A20P45). Bundle tension was recorded during knee flexion-extension. A pivot shift test was also evaluated. Femoral tunnel positions of the AMB and PLB were then assessed by three-dimensional computed tomography, and the correlation between femoral tunnel position and tension change pattern or residual pivot shift was evaluated.

Results: The depth of the PLB tunnel position was correlated with the extent of tension reduction in the PLB between 0° and 30° irrespective of graft fixation settings, while neither the AMB tunnel position nor the height of the PLB tunnel position affected the tension change pattern. Ten cases showed grade 1 pivot shift only in the A20P0 setting. The PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases (27.5 ± 6.2 and 34.1 ± 5.5%, respectively, P = 0.002).

Conclusions: In anatomic double-bundle reconstruction, deeper PLB tunnel position was correlated with the larger tension reduction in the PLB between 0° and 30°. Fixation of the AMB at 20° and the PLB at 0° resulted in residual pivot shift phenomenon in 10/45 cases, and the PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases. In anatomic double-bundle reconstruction, the placement of PLB femoral tunnel must not be too deep, as it might lead to significant tension reduction in the PLB near extension and thus insufficient tension in the PLB, resulting in residual pivot shift phenomenon.

Level Of Evidence: IV.

Citing Articles

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant-preserving anterior cruciate ligament reconstruction.

Zhang K, Meng Q, Zhang J, Gao Y, Yang Y, Liu P Knee Surg Sports Traumatol Arthrosc. 2023; 31(12):5932-5939.

PMID: 37955676 DOI: 10.1007/s00167-023-07656-w.

Rate of Tibial Tunnel Malposition Is Not Changed by Drilling Entirely Within the Stump of Preserved Remnants During ACL Reconstruction: A Prospective Comparative 3D-CT Study.

de Padua V, Saithna A, Chagas E, Zutin T, Piazzalunga L, Patriarcha L Orthop J Sports Med. 2021; 9(10):23259671211037324.

PMID: 34646899 PMC: 8504236. DOI: 10.1177/23259671211037324.

Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography.

Kamitani A, Hara K, Arai Y, Atsumi S, Takahashi T, Nakagawa S Orthop J Sports Med. 2021; 9(2):2325967121992134.

PMID: 33738312 PMC: 7934042. DOI: 10.1177/2325967121992134.

Revascularization to the bone tunnel wall after anterior cruciate ligament reconstruction may relate to the distance from the vessels.

Arai Y, Hara K, Inoue H, Kanamura H, Nakagawa S, Atsumi S Knee Surg Relat Res. 2020; 32(1):53.

PMID: 33023675 PMC: 7541268. DOI: 10.1186/s43019-020-00070-3.

Risk factors for residual pivot shift after anterior cruciate ligament reconstruction: data from the MAKS group.

Ueki H, Nakagawa Y, Ohara T, Watanabe T, Horie M, Katagiri H Knee Surg Sports Traumatol Arthrosc. 2018; 26(12):3724-3730.

PMID: 29947841 DOI: 10.1007/s00167-018-5005-4.

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