Divergence in Femoral Tunnel during Arthroscopic Single Incision Anterior Cruciate Ligament Reconstruction Using by Bone - Patellar Tendon - Bone / 대한정형외과학회잡지

Divergent placement of the femoral interference screw has been described as a major pitfall in single incision endoscopic reconstruction of the anterior cruciate ligament. This study reviews the radiographic results in 30 consecutive endoscopic single-incision ACL reconstructions using interference screw fixation to find a method to reduce the divergent femoral screw fixation. We measured the angles which were determined by a line through axis of femoral bone block and axis of interference screw in anteroposterior and lateral view of knee(APD/LD),through axis of femoral tunnel and axis of tibial tunnel in the full extension-anteroposterior view(AFT),through the longitudinal axis of distal femoral shaft and axis of femoral tunnel in the anteroposterior and lateral view(APFT/LFT). Average LD(4.96+/-62degrees) was significantly larger than average APD(1.303+/-13degrees) (P=0.008). Significant correlation was present between APD and APFT(g=-0.3882, P=0.034), between LD and LFT(gamma=0.6933, P=0.000) and other variables had no significant correlation. The femoral divergence in the anteroposterior plane occurred in the case with small angle between longitudinal axis of femoral shaft and that of femoral tunnel, and vice versa in lateral plane. During drilling of femoral tunnel, more than 90 flexion causes LFT to increase and the risk of femoral divergence increases. Therefore, in the anteroposterior plane, angle between femoral tunnel and longitudinal axis of femoral shaft shoud be made as large as possible and flexion of knee should not be more than 90 during drilling of femoral tunnel.

Radiologic assessment of Endoscopically reconstructed ACL using Bone - patellar tendon - bone / 대한정형외과학회잡지

Endoscopic ACL reconstruction using bone-patellar tendon-bone has been considered the gold standard in the field of reconstructive ACL surgery. Technically, graft must be placed at isometric point. But it is difficult to evaluate the placement of graft postoperatively. The purpose of this study is to determine the radiological ideal position of graft by comparing postoperative results with the graft placement. Seventy cases of endoscopic ACL reconstruction were reviewed and classified according to the femoral and tibial graft position on radiologic imaging. The femoral graft position was classified in relation to angle of graft on anterior position view and distance from posterior margin of graft to the inner surface of posterior cortex on lateral view. The tibial graft position was classified in relation to intercondylar eminence on anterior posterior view and lateral view. Knee score (modified Marshall, Lysholum), manual anterior instability test (Lachman test, Pivot shift test) and arthrometer measurement were checked to evaluate postoperative results in each case. The results of this study implicate that knee joint in which femoral graft was oriented at direction of 11 o clock centring around 68 degree respect to tibial joint and placed within 3mm from posterior cortex showed higher knee score and lesser laxity. In cases of tibial side, the graft oriented to intercondylar eminence (AP view) and placed anterior to intercondylar eminence (lateral view) showed higher knee score and lesser laxity.

Clinical Verification of the Calculation of Tibial Tunnel Length in Endoscopic ACL Reconstruction

Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Tibial tunnel length is a factor that affect graft fixation, potential impingement, and graft abrasion. Appropriate tunnel length is a critical tecpnical consideration. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult... A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. This grafl-tunnel mismatch can be avoided if fhe sum of the tibial tunnel length plus the intraarticular distance of ACL is equal to or greater than the graft tendon length plus 20mm (the minimum interference fixation possible when using the smallest available 20 mm long interference screw). Authors published an article to determine the reiationship between the length of patellar tendon and that of anterior cruciate ligament, to calculate the tibial tunnel length through the dissection of 19 cadaveric knees (ACL length (mm)=0.73 X Patellar tendon length-2.69 (p

Endoscopic ACL Reconstruction / 대한정형외과학회잡지

Endoscopic anterior cruciate ligament reconstruction using central one-third of bone-patellar tendon-bone autografts were performed on 76 consecutive patients. 36 patients out of them were reviewed and evaluated with subjective and functional rating scales according to the Lysholm knee scoring system, physical examination and instrumented anterior laxity test. The average follow-up was 2 years and 1 month, ranging from 1 year and 6 months to 3 years and 8 months and the everage age at operation was 31 years old, ranging from 20 to 49 years old. At follow-up, the average Lysholm knee score was 87.2 compared to the average score of 49.5 prior to reconstruction. Physical examination and instrumented anterior laxity test showed that excellent anterior stability was regained in all patients but two. There were 4 cases of complication, a fibrous nodule anterior to reconstructed ACL, an effusion of knee, a thrombophlebits, and an inadequate placement of screw fixation with protrusion of bone peg out of tibial hole. In summary, endoscopic ACL reconstruction using central 1/3 of bone-patellar tendon-bone seems to be a good procedure, which leaves less operative scar, takes short operation time and gives a constant good result as far as the surgeon is familiar with the technique.