Tunnel Convergence Rate in Combined Anteromedial Portal Anterior Cruciate Ligament and Anterolateral Structure Reconstructions Is Influenced by Anterior Cruciate Ligament Knee Flexion Angle, Tunnel Position, and Direction.
Journal
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
ISSN: 1526-3231
Titre abrégé: Arthroscopy
Pays: United States
ID NLM: 8506498
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
19
10
2020
revised:
08
05
2021
accepted:
14
05
2021
pubmed:
31
5
2021
medline:
11
3
2022
entrez:
30
5
2021
Statut:
ppublish
Résumé
The goal of the present study was to evaluate a potential tunnel convergence in combined anterior cruciate ligament (ACL) reconstruction using the anteromedial portal technique and lateral extra-articular tenodesis (LET). Ten fresh frozen femora were dissected and a K-wires were inserted into the middle of the ACL stump, according to an ACL reconstruction at 110° and 140° knee flexion. ACL reconstruction at 120° and 130° was simulated. Seven K-wires with different femoral insertion sites and angulations were drilled into the lateral femoral condyle relative to the lateral epicondyle (E3: 8 mm proximal and 4 mm posterior; E1: 5 mm proximal and 5 mm anterior and E2: over-the-top position). Tunnel conflict rate was evaluated using a measuring arm and a metrology software. Drilling the femoral ACL tunnel in low knee flexion (110°-120°) significantly (P < .001) reduced the tunnel conflict rate compared to the ACL drilled in high knee flexion (130°-140°). Changing the insertion point from proximal and posterior (E3) to proximal and anterior (E1) showed a reduced tunnel conflict rate from 40 ± 21.2% to 15 ± 26% and no tunnel conflict for an ACL drilled at 110°-130° knee flexion. A possible tunnel conflict in simultaneous ACL reconstruction using the AMP technique and LET was dependent on ACL knee flexion angle, LET insertion site, and angulation. This posed the dilemma that no generally applicable LET configuration could be recommended to avoid a tunnel conflict. However, it appears that an insertion point located proximal and anterior to the lateral epicondyle results in less tunnel conflicts than an insertion point located proximal and posterior. An insertion point located proximal and anterior to the lateral epicondyle with a 30° proximal and 30° anterior angulation could reliably avoid a tunnel conflict when the ACL was drilled between 110 and 130° using a low anteromedial portal.
Identifiants
pubmed: 34052378
pii: S0749-8063(21)00514-4
doi: 10.1016/j.arthro.2021.05.028
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
860-869Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.