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Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction

The aim of this study was to review and update the literature in regard to the anatomy of the femoral origin of the ACL, the concept of the double band and its respective mechanical functions, and the concept of direct and indirect fibres in the ACL insertion. These topics will be used to help deter...

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Autores principales: Jorge, Pedro Baches, Escudeiro, Diego, Severino, Nilson Roberto, Santili, Cláudio, de Paula Leite Cury, Ricardo, Junior, Aires Duarte, Guglielmetti, Luiz Gabriel Betoni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173259/
https://www.ncbi.nlm.nih.gov/pubmed/30305927
http://dx.doi.org/10.1136/bmjsem-2018-000420
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author Jorge, Pedro Baches
Escudeiro, Diego
Severino, Nilson Roberto
Santili, Cláudio
de Paula Leite Cury, Ricardo
Junior, Aires Duarte
Guglielmetti, Luiz Gabriel Betoni
author_facet Jorge, Pedro Baches
Escudeiro, Diego
Severino, Nilson Roberto
Santili, Cláudio
de Paula Leite Cury, Ricardo
Junior, Aires Duarte
Guglielmetti, Luiz Gabriel Betoni
author_sort Jorge, Pedro Baches
collection PubMed
description The aim of this study was to review and update the literature in regard to the anatomy of the femoral origin of the ACL, the concept of the double band and its respective mechanical functions, and the concept of direct and indirect fibres in the ACL insertion. These topics will be used to help determine which might be the best place to position the femoral tunnel and how this should be achieved, based on the idea of functional positioning, that is, where the most important ACL fibres in terms of knee stability are positioned. Low positioning of the femoral tunnel, reproducing more of the posterolateral band, and positioning the tunnel away from the lateral intercondylar ridge, that is, in the indirect fibres, would theoretically rebuild a ligament that is less effective in relation to knee stability. The techniques described to determine the femoral tunnel’s centre point all involve some degree of subjectivity; the point is defined manually and depends on the surgeon’s expertise. The centre of the ACL insertion in the femur should be used as a parameter. Once the centre of the ligament in its footprint is marked, the centre of the tunnel must be defined, drawing the marking toward the intercondylar ridge and anteromedial band. This will allow the femoral tunnel to occupy the region containing the most important original ACL fibres in terms of this ligament’s function.
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spelling pubmed-61732592018-10-10 Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction Jorge, Pedro Baches Escudeiro, Diego Severino, Nilson Roberto Santili, Cláudio de Paula Leite Cury, Ricardo Junior, Aires Duarte Guglielmetti, Luiz Gabriel Betoni BMJ Open Sport Exerc Med Review The aim of this study was to review and update the literature in regard to the anatomy of the femoral origin of the ACL, the concept of the double band and its respective mechanical functions, and the concept of direct and indirect fibres in the ACL insertion. These topics will be used to help determine which might be the best place to position the femoral tunnel and how this should be achieved, based on the idea of functional positioning, that is, where the most important ACL fibres in terms of knee stability are positioned. Low positioning of the femoral tunnel, reproducing more of the posterolateral band, and positioning the tunnel away from the lateral intercondylar ridge, that is, in the indirect fibres, would theoretically rebuild a ligament that is less effective in relation to knee stability. The techniques described to determine the femoral tunnel’s centre point all involve some degree of subjectivity; the point is defined manually and depends on the surgeon’s expertise. The centre of the ACL insertion in the femur should be used as a parameter. Once the centre of the ligament in its footprint is marked, the centre of the tunnel must be defined, drawing the marking toward the intercondylar ridge and anteromedial band. This will allow the femoral tunnel to occupy the region containing the most important original ACL fibres in terms of this ligament’s function. BMJ Publishing Group 2018-10-01 /pmc/articles/PMC6173259/ /pubmed/30305927 http://dx.doi.org/10.1136/bmjsem-2018-000420 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Review
Jorge, Pedro Baches
Escudeiro, Diego
Severino, Nilson Roberto
Santili, Cláudio
de Paula Leite Cury, Ricardo
Junior, Aires Duarte
Guglielmetti, Luiz Gabriel Betoni
Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title_full Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title_fullStr Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title_full_unstemmed Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title_short Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
title_sort positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173259/
https://www.ncbi.nlm.nih.gov/pubmed/30305927
http://dx.doi.org/10.1136/bmjsem-2018-000420
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