Brian C Werner1, M Tyrrell Burrus2, F Winston Gwathmey2, Mark D Miller2. 1. Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA. Electronic address: bcw4x@virginia.edu. 2. Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
Abstract
BACKGROUND: The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau. RESULTS: The average anteroposterior (A-P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%-49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A-P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%-29.9% (6 patients) or 45.0%-49.9% (10 patients). CONCLUSIONS: Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location. LEVEL OF EVIDENCE: II, Prospective study.
BACKGROUND: The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau. RESULTS: The average anteroposterior (A-P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%-49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A-P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%-29.9% (6 patients) or 45.0%-49.9% (10 patients). CONCLUSIONS: Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location. LEVEL OF EVIDENCE: II, Prospective study.
Authors: Abigail L Campbell; Jon-Michael E Caldwell; Dheeraj Yalamanchili; Lia Sepanek; Keon Youssefzadeh; Carlos A Uquillas; Orr Limpisvasti Journal: Orthop J Sports Med Date: 2021-05-03