PURPOSE: To examine the relationship between the radiographically assessed placement of the tibial tunnel and the long-term clinical and subjective outcome in anterior cruciate ligament-reconstructed patients. METHODS: Patients were examined clinically, with subjective score systems and with standardised radiographs 10-12 years postoperatively. Only patients reconstructed with the aid of the 70-degree tibial drill guide were included. A posterior placement of the tibial tunnel was defined as >50% along the Amis and Jakob line (AJL). A high tunnel inclination was defined as >75° in the coronal plane. The possible linear relationships between clinical findings, subjective scores and tibial tunnel placement were investigated. RESULTS: Eighty-six percentage of the 96 patients were available for examination. Mean tibial tunnel inclination was 71.1° (SD 4.2). No difference was found in subjective scores and knee stability between high (14%) and low (86%) inclination groups. Mean placement of the tibial tunnel along the AJL was 46% (SD 5). Patients with a posterior tibial tunnel placement (24%) had a higher incidence of rotational instability (P = 0.02). Patients with rotational instability (grade 2 pivot shift) had significant lower Lysholm score than those with grade 0 and 1 rotational instability (P = 0.001). CONCLUSIONS: The use of a tibial drill guide that relates to the femoral roof leads to a posterior tibial tunnel placement (>50% of the tibial AP-diameter) in 24% of the patients. These patients have a significant higher proportion of rotational instability and worse subjective outcome. LEVEL OF EVIDENCE: Case series, Level IV.
PURPOSE: To examine the relationship between the radiographically assessed placement of the tibial tunnel and the long-term clinical and subjective outcome in anterior cruciate ligament-reconstructed patients. METHODS:Patients were examined clinically, with subjective score systems and with standardised radiographs 10-12 years postoperatively. Only patients reconstructed with the aid of the 70-degree tibial drill guide were included. A posterior placement of the tibial tunnel was defined as >50% along the Amis and Jakob line (AJL). A high tunnel inclination was defined as >75° in the coronal plane. The possible linear relationships between clinical findings, subjective scores and tibial tunnel placement were investigated. RESULTS: Eighty-six percentage of the 96 patients were available for examination. Mean tibial tunnel inclination was 71.1° (SD 4.2). No difference was found in subjective scores and knee stability between high (14%) and low (86%) inclination groups. Mean placement of the tibial tunnel along the AJL was 46% (SD 5). Patients with a posterior tibial tunnel placement (24%) had a higher incidence of rotational instability (P = 0.02). Patients with rotational instability (grade 2 pivot shift) had significant lower Lysholm score than those with grade 0 and 1 rotational instability (P = 0.001). CONCLUSIONS: The use of a tibial drill guide that relates to the femoral roof leads to a posterior tibial tunnel placement (>50% of the tibial AP-diameter) in 24% of the patients. These patients have a significant higher proportion of rotational instability and worse subjective outcome. LEVEL OF EVIDENCE: Case series, Level IV.
Authors: Asheesh Bedi; Travis Maak; Volker Musahl; Musa Citak; Padhraig F O'Loughlin; Daniel Choi; Andrew D Pearle Journal: Am J Sports Med Date: 2010-12-20 Impact factor: 6.202
Authors: Pierluigi Cuomo; Andrew Edwards; Francesco Giron; Anthony M J Bull; Andrew A Amis; Paolo Aglietti Journal: Arthroscopy Date: 2006-01 Impact factor: 4.772
Authors: Mattias Ahldén; Kristian Samuelsson; Ninni Sernert; Magnus Forssblad; Jón Karlsson; Jüri Kartus Journal: Am J Sports Med Date: 2012-09-07 Impact factor: 6.202
Authors: Tim T C R de Mees; Max Reijman; Jan Hendrik Waarsing; Duncan E Meuffels Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-02-02 Impact factor: 4.114