Optimal Entry Position on the Lateral Femoral Surface for Outside-in Drilling Technique to Restore the Anatomical Footprint of Anterior Cruciate Ligament

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2014 Nov 29

PMID 25429767

Citations 3

Authors

Hirokazu Matsubara

Ken Okazaki

Kanji Osaki

Yasutaka Tashiro

Hideki Mizu-Uchi

Satoshi Hamai

Yukihide Iwamoto

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the optimal starting points for drilling on the lateral femoral condyle for better coverage of the anatomical footprint of the anterior cruciate ligament (ACL) using the outside-in (OI) technique in a single-bundle ACL reconstruction.

Methods: Femoral tunnel drilling was simulated on three-dimensional bone models from 40 subjects by connecting the centre of the ACL footprint with various points on the lateral femoral surface. The percentage of the femoral footprint covered by apertures of the virtual tunnel sockets with 9 mm diameter was calculated for each tunnel.

Results: The mean percentages of the femoral footprint covered by the apertures of the virtual tunnel sockets were significantly higher when drilled at 2 and 3 cm from the lateral epicondyle on a 45° line and a 60° line anterior from the proximal-distal axis than the other points. However, articular cartilage damage was occurred in nine subjects at 3 cm on a 60° line and eight subjects at 3 cm on a 45° line. Posterior wall blowout occurred in five subjects at 3 cm on a 45° line. Thus, OI drilling at 3 cm from the epicondyle has a risk of these complications.

Conclusion: During the OI drilling of the femoral tunnel, connecting the centre of the anatomical footprint of the ACL and the entry drilling point at 2 cm from the lateral epicondyle on between the 45° line and the 60° line anterior from the proximal-distal axis provides an oval-shaped socket aperture that covers and restores the native ACL footprint as nearly as possible.

Level Of Evidence: III.

Citing Articles

The Ideal Cortical Button Location on the Lateral Femur for Anterior Cruciate Ligament Suspensory Fixation is 30 mm Proximal to the Lateral Epicondyle.

Massey P, Caldwell C, Vauclin C, Hoefler A, Berken D, Barton R Arthrosc Sports Med Rehabil. 2021; 3(5):e1255-e1262.

PMID: 34712961 PMC: 8527268. DOI: 10.1016/j.asmr.2021.03.018.

Aperture elongation of the femoral tunnel on the lateral cortex in anatomical double-bundle anterior cruciate ligament reconstruction using the outside-in technique.

Akaoka Y, Tensho K, Shimodaira H, Koyama S, Iwaasa T, Horiuchi H Medicine (Baltimore). 2020; 99(38):e22053.

PMID: 32957326 PMC: 7505402. DOI: 10.1097/MD.0000000000022053.

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction.

Tashiro Y, Irarrazaval S, Osaki K, Iwamoto Y, Fu F Knee Surg Sports Traumatol Arthrosc. 2016; 25(1):129-137.

PMID: 27277192 DOI: 10.1007/s00167-016-4191-1.

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