Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction

A biomechanical study

Matthew D. Driscoll, Gene P. Isabell, Michael A. Conditt, Sabir K. Ismaily, Daniel Jupiter, Philip C. Noble, Walter R. Lowe

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose: To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. Methods: Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. Results: In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P =.03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P >.05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P <.05). Conclusion: Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. Clinical Relevance: This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.

Original languageEnglish (US)
Pages (from-to)1481-1489
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume28
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament Reconstruction
Thigh
Anterior Cruciate Ligament
Knee
Bone and Bones
Patellar Ligament
Autografts
Torque
Biomechanical Phenomena

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction : A biomechanical study. / Driscoll, Matthew D.; Isabell, Gene P.; Conditt, Michael A.; Ismaily, Sabir K.; Jupiter, Daniel; Noble, Philip C.; Lowe, Walter R.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 28, No. 10, 10.2012, p. 1481-1489.

Research output: Contribution to journalArticle

Driscoll, Matthew D. ; Isabell, Gene P. ; Conditt, Michael A. ; Ismaily, Sabir K. ; Jupiter, Daniel ; Noble, Philip C. ; Lowe, Walter R. / Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction : A biomechanical study. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2012 ; Vol. 28, No. 10. pp. 1481-1489.
@article{62834ab0e3d64f49b9a4a9fd5135787a,
title = "Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: A biomechanical study",
abstract = "Purpose: To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. Methods: Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. Results: In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P =.03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P >.05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P <.05). Conclusion: Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. Clinical Relevance: This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.",
author = "Driscoll, {Matthew D.} and Isabell, {Gene P.} and Conditt, {Michael A.} and Ismaily, {Sabir K.} and Daniel Jupiter and Noble, {Philip C.} and Lowe, {Walter R.}",
year = "2012",
month = "10",
doi = "10.1016/j.arthro.2012.03.019",
language = "English (US)",
volume = "28",
pages = "1481--1489",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
issn = "0749-8063",
publisher = "W.B. Saunders Ltd",
number = "10",

}

TY - JOUR

T1 - Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction

T2 - A biomechanical study

AU - Driscoll, Matthew D.

AU - Isabell, Gene P.

AU - Conditt, Michael A.

AU - Ismaily, Sabir K.

AU - Jupiter, Daniel

AU - Noble, Philip C.

AU - Lowe, Walter R.

PY - 2012/10

Y1 - 2012/10

N2 - Purpose: To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. Methods: Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. Results: In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P =.03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P >.05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P <.05). Conclusion: Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. Clinical Relevance: This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.

AB - Purpose: To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. Methods: Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. Results: In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P =.03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P >.05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P <.05). Conclusion: Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. Clinical Relevance: This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.

UR - http://www.scopus.com/inward/record.url?scp=84866904653&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866904653&partnerID=8YFLogxK

U2 - 10.1016/j.arthro.2012.03.019

DO - 10.1016/j.arthro.2012.03.019

M3 - Article

VL - 28

SP - 1481

EP - 1489

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

IS - 10

ER -