No Correlation Between Femoral Tunnel Orientation and Clinical Outcome at Long-term Follow-up After Non-anatomic Anterior Cruciate Ligament Reconstruction

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2019 Feb 2

PMID 30707249

Citations 4

Authors

David Sundemo

Julia Martensson

Eric Hamrin Senorski

Eleonor Svantesson

Juri Kartus

Ninni Sernert

Jon Karlsson

Kristian Samuelsson

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to determine the influence of femoral tunnel orientation on long-term clinical outcome and osteoarthritis in patients undergoing ACL reconstruction and to test the reliability of the implemented radiographic measurement methods. It was hypothesized that a more horizontal femoral tunnel would correlate with superior clinical outcome.

Methods: A cohort of 193 patients who underwent non-anatomic ACL reconstruction was examined. In this specific study, non-anatomic is defined by the surgeons' pursuit of optimal isometry, not to emulate the native ACL anatomy. At follow-up, the Lachman test, the KT-1000, the pivot-shift test, the one-leg-hop test and the IKDC-2000 were evaluated. Osteoarthritis was evaluated radiographically. Posteroanterior and lateral radiographs were used to determine the position of the femoral tunnel in the coronal and sagittal planes and the angle of the tunnel in the coronal plane. A method for determining femoral rotation on the lateral radiographs was developed and its reliability was evaluated. The femoral tunnel orientation was analyzed to examine its influence on clinical outcome and osteoarthritis.

Results: A total of 101 patients were analyzed at a mean of 16.4 (± 1.3) years postoperatively. The reliability of the measurement methods was regarded as good to excellent (ICC 0.57-0.97). The mean coronal femoral tunnel angle was 9.6° (± 9.4°). The coronal femoral tunnel was positioned at a mean of 43% (± 3.5%) of the distance measured from lateral to medial. The mean sagittal femoral tunnel position, measured using the quadrant method, was 40% (± 6.4%) from posterior to anterior. No significant associations were found between tunnel orientation and the clinical outcome variables.

Conclusions: The orientation of the femoral tunnel did not predict the long-term subjective outcome, functional outcome or the development of osteoarthritis in patients undergoing non-anatomic ACL reconstruction. The method for determining femoral rotation on lateral radiographs was found to be reliable.

Level Of Evidence: Retrospective cohort study, level of evidence IV.

Citing Articles

The Influence of Tunnel Parameters and Graft Inclination Angle on Clinical and Radiological Outcome at Long-term Follow-up after Arthroscopic Anterior Cruciate Ligament Reconstruction.

Santhamoorthy T, Xavier A, Krun K, Dubey D Rev Bras Ortop (Sao Paulo). 2024; 59(2):e189-e198.

PMID: 38606131 PMC: 11006531. DOI: 10.1055/s-0044-1785493.

The 25-year experience of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: the story so far.

Zaffagnini S, Lucidi G, Macchiarola L, Agostinone P, Neri M, Marcacci M J Exp Orthop. 2023; 10(1):36.

PMID: 37005946 PMC: 10067780. DOI: 10.1186/s40634-023-00599-8.

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction.

Chiba D, Yamamoto Y, Kimura Y, Sasaki E, Sasaki S, Tsuda E Orthop J Sports Med. 2022; 10(7):23259671221109608.

PMID: 35898202 PMC: 9310230. DOI: 10.1177/23259671221109608.

Posteriorly positioned femoral grafts decrease long-term failure in anterior cruciate ligament reconstruction, femoral and tibial graft positions did not affect long-term reported outcome.

de Mees T, Reijman M, Waarsing J, Meuffels D Knee Surg Sports Traumatol Arthrosc. 2022; 30(6):2003-2013.

PMID: 35112176 PMC: 9165258. DOI: 10.1007/s00167-022-06871-1.

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