Shunichiro Kambara1, Hiroshi Nakayama2, Motoi Yamaguchi3, Akio Matsumoto3, Ken Sasaki3, Kaori Kashiwa2, Tomoya Iseki2, Shinichi Yoshiya2. 1. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: shunkazu19810723@hotmail.co.jp. 2. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. 3. Department of Orthopaedic Surgery, Meiwa General Hospital, 4-31 Agenaruo-cho Nishinomiya, Hyogo 663-8186, Japan.
Abstract
PURPOSE: To comparatively analyze the geometry of the posterolateral femoral (PL) tunnel in double-bundle ACL reconstruction between far anteromedial transportal (TP) and outside-in (OI) drilling techniques based on three-dimensional computed tomography (3DCT) image analysis. METHODS: Forty patients who underwent anatomic double-bundle hamstring ACL reconstruction using the TP (n: 20) or OI (n: 20) method with postoperative CT data available were included in the study. The analyzed parameters were as follows: location of the intraarticular tunnel aperture, tunnel length, bending angle (angulation of the graft at the intraarticular tunnel aperture), and long axis of the tunnel aperture/drill diameter ratio as a parameter of ellipsoidal geometry. RESULTS: Anatomical tunnel placement was achieved in both groups. Coalition of the AM and PL tunnel apertures was found in 3 knees in the TP group and 1 knee in the OI group, though no significant difference in the rate of this problem was demonstrated between the groups (P: 0.30). The tunnel length was not significantly different between the groups, while the graft bending angle at the tunnel aperture was significantly larger in the OI group than the TP group (99.4° vs. 63.6°). The long axis/drill diameter ratio averaged 1.23 in the TP group and 1.13 in the OI group with significant intergroup difference. CONCLUSION: When drilling the PL femoral tunnel in double-bundle ACL reconstruction, anatomic placement of the intraarticular tunnel aperture was feasible in both the TP and OI techniques. The tunnel aperture was rounder and the graft bending angle in knee extended position at the intraarticular aperture was more acute in the OI technique than the TP technique. LEVEL OF EVIDENCE: Level IV (retrospective comparison of the two patient groups treated at different hospitals).
PURPOSE: To comparatively analyze the geometry of the posterolateral femoral (PL) tunnel in double-bundle ACL reconstruction between far anteromedial transportal (TP) and outside-in (OI) drilling techniques based on three-dimensional computed tomography (3DCT) image analysis. METHODS: Forty patients who underwent anatomic double-bundle hamstring ACL reconstruction using the TP (n: 20) or OI (n: 20) method with postoperative CT data available were included in the study. The analyzed parameters were as follows: location of the intraarticular tunnel aperture, tunnel length, bending angle (angulation of the graft at the intraarticular tunnel aperture), and long axis of the tunnel aperture/drill diameter ratio as a parameter of ellipsoidal geometry. RESULTS: Anatomical tunnel placement was achieved in both groups. Coalition of the AM and PL tunnel apertures was found in 3 knees in the TP group and 1 knee in the OI group, though no significant difference in the rate of this problem was demonstrated between the groups (P: 0.30). The tunnel length was not significantly different between the groups, while the graft bending angle at the tunnel aperture was significantly larger in the OI group than the TP group (99.4° vs. 63.6°). The long axis/drill diameter ratio averaged 1.23 in the TP group and 1.13 in the OI group with significant intergroup difference. CONCLUSION: When drilling the PL femoral tunnel in double-bundle ACL reconstruction, anatomic placement of the intraarticular tunnel aperture was feasible in both the TP and OI techniques. The tunnel aperture was rounder and the graft bending angle in knee extended position at the intraarticular aperture was more acute in the OI technique than the TP technique. LEVEL OF EVIDENCE: Level IV (retrospective comparison of the two patient groups treated at different hospitals).