Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Arthroscopic Revision ACL Reconstruction

PURPOSE: We analyzed the 11 knees in 11 patients who had arthroscopic revision anterior cruciate liga-ment(ACL) reconstruction and demonstrate the causes of failure of ACL reconstruction and report the clinical result of arthroscopic revision ACL reconstruction. MATERIALS AND METHODS: From March 1997 to April 1999, 11 patients who underwent ACL reconstruction at other hospital had been treated by revision ACL reconstruction. Their mean age at revision was 26.4 years, average time from primary to revision surgery was 26.8 months and average length of follow up was 22 months. We evaluated the results of revision surgery by symptom, Lysholm knee score, physical examination and KT-100 arthrometer. RESULTS: The causes of failure of ACL reconstruction were 8 improper tunnel placements(6 femoral tunnels, 2 tibial tunnels), 2 graft incorporation failure and 1 multiple ligament injury(N=l 1). After revi- sion all patients had improved symptom. There was improvement of average Lysholm knee score from 70 to 87( 2 excellents, 7 goods, 1 fair, 1 poor) with success rate of 82%( 9/11). The data showed decrease of the mean side to side difference from 10.9 mm to 1.7 mm by KT-1000 arthrometer. CONCLUSION: The most common causes of failure of ACL reconstruction were surgical techniques and anatomical tunnel placement was the most important among them.

Radiologic and Clinical Evaluation after Arthroscopic Reconstruction of Anterior Cruciate Ligament Using Autogenous Bone-Patellar Tendon-Bone Graft

PURPOSE: The purpose of this study was to correlate radiological analysis(as divergence of femoral tun-nel and interference screw and tunnel placement) with clinical results(as physical examination, Lysholm knee scoring scale, and side to side difference of anterior displacement in an arthrometer). MATERIALS AND METHODS: This study reviewed radiological and clinical results in 48 endoscopic single-incision ACL reconstruction, using autogenous bone-patellar tendon-bone graft and interference screw fixation, between January 1995 and October 1997. We measured the femoral divergence in antero-poste-rior and lateral views of the knee(APD/LD), the angle between a line through the longitudinal axis of dis-tal femoral shaft, and the axis of femoral tunnel in antero-posterior and lateral views(APFT/LFT). We also measured the placement of a tunnel in antero-posterior and lateral views. RESULTS: Significant correlation was present between APD and APFT(negatively) and between LD and LFT(positively), while other variables had no significant correlation. Furthermore, there was no signifi-cant correlation between divergence and clinical results. Clinical results correlated positively with posteri-or femoral tunnel placement on lateral radiographs and negatively with excessive anterior tibial tunnel placement. Therefore, when femoral tunnels were placed at least 60% posterior along the Blumenssat's line and tibial tunnels were placed at least 20% posterior along the tibial plateau, 77.1% of the patients had good or excellent Lysholm score and 80% of the patients had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. When the above criteria were not met, however, only 53.8% of the patients had good or excellent Lysholm score and 53.8% had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. CONCLUSIONS: This close correlation indicated that satisfactory radiographic tunnel position influences the outcome of an ACL reconstruction.