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Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model

BACKGROUND: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement through the anteromedial (AM) portal technique requires more horizontal drilling of the femoral tunnel as compared with the transtibial (TT) technique, which may lead to a shorter femoral tunnel and affect graft...

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Autores principales: Dimitriou, Dimitris, Cheng, Rongshan, Yang, Yangyang, Helmy, Naeder, Tsai, Tsung-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149612/
https://www.ncbi.nlm.nih.gov/pubmed/35651481
http://dx.doi.org/10.1177/23259671221096417
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author Dimitriou, Dimitris
Cheng, Rongshan
Yang, Yangyang
Helmy, Naeder
Tsai, Tsung-Yuan
author_facet Dimitriou, Dimitris
Cheng, Rongshan
Yang, Yangyang
Helmy, Naeder
Tsai, Tsung-Yuan
author_sort Dimitriou, Dimitris
collection PubMed
description BACKGROUND: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement through the anteromedial (AM) portal technique requires more horizontal drilling of the femoral tunnel as compared with the transtibial (TT) technique, which may lead to a shorter femoral tunnel and affect graft-to-bone healing. The effect of coronal and sagittal femoral tunnel obliquity angle on femoral tunnel length has not been investigated. PURPOSE: To compare the length of the femoral tunnels created with the TT technique versus the AM portal technique at different coronal and sagittal obliquity angles using the native femoral ACL center as the starting point of the femoral tunnel. The authors also assessed sex-based differences in tunnel lengths. STUDY DESIGN: Descriptive laboratory study. METHODS: Magnetic resonance imaging scans of 95 knees with an ACL rupture (55 men, 40 women; mean age, 26 years [range, 16-45 years]) were used to create 3-dimensional models of the femur. The femoral tunnel was simulated on each model using the TT and AM portal techniques; for the latter, several coronal and sagittal obliquity angles were simulated (coronal, 30°, 45°, and 60°; sagittal, 45° and 60°), representing the 10:00, 10:30, and 11:00 clockface positions for the right knee. The length of the femoral tunnel was compared between the techniques and between male and female patients. RESULTS: The mean ± SD femoral tunnel length with the TT technique was 40.0 ± 6.8 mm. A significantly shorter tunnel was created with the AM portal technique at 30° coronal/45° sagittal (35.5 ± 3.8 mm), whereas a longer tunnel was created at 60° coronal/60° sagittal (53.3 ± 5.3 mm; P < .05 for both). The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal (40.7 ± 4.8 mm) created a similar tunnel length as the TT technique. For all techniques, the femoral tunnel was significantly shorter in female patients than male patients. CONCLUSION: The coronal and sagittal obliquity angles of the femoral tunnel in ACL reconstruction can significantly affect its length. The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal was similar to that created with the TT technique. CLINICAL RELEVANCE: Surgeons should be aware of the femoral tunnel shortening with lower coronal obliquity angles, especially in female patients.
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spelling pubmed-91496122022-05-31 Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model Dimitriou, Dimitris Cheng, Rongshan Yang, Yangyang Helmy, Naeder Tsai, Tsung-Yuan Orthop J Sports Med Article BACKGROUND: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement through the anteromedial (AM) portal technique requires more horizontal drilling of the femoral tunnel as compared with the transtibial (TT) technique, which may lead to a shorter femoral tunnel and affect graft-to-bone healing. The effect of coronal and sagittal femoral tunnel obliquity angle on femoral tunnel length has not been investigated. PURPOSE: To compare the length of the femoral tunnels created with the TT technique versus the AM portal technique at different coronal and sagittal obliquity angles using the native femoral ACL center as the starting point of the femoral tunnel. The authors also assessed sex-based differences in tunnel lengths. STUDY DESIGN: Descriptive laboratory study. METHODS: Magnetic resonance imaging scans of 95 knees with an ACL rupture (55 men, 40 women; mean age, 26 years [range, 16-45 years]) were used to create 3-dimensional models of the femur. The femoral tunnel was simulated on each model using the TT and AM portal techniques; for the latter, several coronal and sagittal obliquity angles were simulated (coronal, 30°, 45°, and 60°; sagittal, 45° and 60°), representing the 10:00, 10:30, and 11:00 clockface positions for the right knee. The length of the femoral tunnel was compared between the techniques and between male and female patients. RESULTS: The mean ± SD femoral tunnel length with the TT technique was 40.0 ± 6.8 mm. A significantly shorter tunnel was created with the AM portal technique at 30° coronal/45° sagittal (35.5 ± 3.8 mm), whereas a longer tunnel was created at 60° coronal/60° sagittal (53.3 ± 5.3 mm; P < .05 for both). The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal (40.7 ± 4.8 mm) created a similar tunnel length as the TT technique. For all techniques, the femoral tunnel was significantly shorter in female patients than male patients. CONCLUSION: The coronal and sagittal obliquity angles of the femoral tunnel in ACL reconstruction can significantly affect its length. The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal was similar to that created with the TT technique. CLINICAL RELEVANCE: Surgeons should be aware of the femoral tunnel shortening with lower coronal obliquity angles, especially in female patients. SAGE Publications 2022-05-26 /pmc/articles/PMC9149612/ /pubmed/35651481 http://dx.doi.org/10.1177/23259671221096417 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Dimitriou, Dimitris
Cheng, Rongshan
Yang, Yangyang
Helmy, Naeder
Tsai, Tsung-Yuan
Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title_full Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title_fullStr Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title_full_unstemmed Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title_short Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model
title_sort influence of the anteromedial portal and transtibial drilling technique on femoral tunnel lengths in acl reconstruction: results using an mri-based model
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149612/
https://www.ncbi.nlm.nih.gov/pubmed/35651481
http://dx.doi.org/10.1177/23259671221096417
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