Yoshiyuki Yahagi1, Takanori Iriuchishima2,3, Takashi Horaguchi1, Makoto Suruga1, Yasuaki Tokuhashi4, Shin Aizawa5. 1. Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan. 2. Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan. sekaiwoseisu@yahoo.co.jp. 3. Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan. sekaiwoseisu@yahoo.co.jp. 4. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan. 5. Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
Abstract
PURPOSE: The purpose of this study was to evaluate the difference in the center position of the ACL footprint based on grid placement using the quadrant method according to the morphological variations of the Blumensaat's line. METHODS: Fifty-nine non-paired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch, and the digital images were evaluated using Image J software. The femoral ACL footprint was periphery outlined and the center position was automatically measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight, small hill, and large hill types. From the images, grid quadrants were placed as: Grid (1) without consideration of hill existence and not including the chondral lesion. Grid (2) without consideration of hill existence and including the chondral lesion. Grid (3) with consideration of hill existence and not including the chondral lesion. Grid (4) with consideration of hill existence and including the chondral lesion. RESULTS: The straight type consisted of 19 knees, the small hill type 13 knees, and the large hill type 27 knees. Depending on the quadrant grid placement, significant center position difference was observed both in the shallow-deep, and high-low direction. When hill existence was considered, the center position of the ACL was significantly changed to a high position. CONCLUSION: The center position of the ACL footprint exhibited significant differences according to Blumensaat's line morphology. For clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially when using the quadrant method.
PURPOSE: The purpose of this study was to evaluate the difference in the center position of the ACL footprint based on grid placement using the quadrant method according to the morphological variations of the Blumensaat's line. METHODS: Fifty-nine non-paired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch, and the digital images were evaluated using Image J software. The femoral ACL footprint was periphery outlined and the center position was automatically measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight, small hill, and large hill types. From the images, grid quadrants were placed as: Grid (1) without consideration of hill existence and not including the chondral lesion. Grid (2) without consideration of hill existence and including the chondral lesion. Grid (3) with consideration of hill existence and not including the chondral lesion. Grid (4) with consideration of hill existence and including the chondral lesion. RESULTS: The straight type consisted of 19 knees, the small hill type 13 knees, and the large hill type 27 knees. Depending on the quadrant grid placement, significant center position difference was observed both in the shallow-deep, and high-low direction. When hill existence was considered, the center position of the ACL was significantly changed to a high position. CONCLUSION: The center position of the ACL footprint exhibited significant differences according to Blumensaat's line morphology. For clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially when using the quadrant method.
Authors: Femke Wolters; Sharon H A Vrooijink; Carola F Van Eck; Freddie H Fu Journal: Knee Surg Sports Traumatol Arthrosc Date: 2011-04-06 Impact factor: 4.342