Abstract
Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome. Seventeen surgeons with different levels of experience (between 0 and >150 ACL reconstructions) performed endoscopic ACL repair in uniform technique from August 2000 to August 2003 on 50 patients (18 women, 32 men, age range 18–43 years). The patients were available to clinical and radiological follow-up after an average of 19 months. The clinical outcome was classified according to the International Knee Documentation Committee (IKDC) standard evaluation form. The femoral tunnel was evaluated according to the quadrant method of Bernard and Hertel; the position of the tibial bone tunnel was assessed according to the criteria of Stäubli and Rauschnig. The IKDC score revealed 47 (94%) patients with a normal (A) or nearly normal (B) knee joint at follow-up. According to the quadrant method, the femoral canal was situated on average at 29% in the saggital plane. The tibial tunnel was situated on average at 43% of the a.p. diameter of the tibial condyle. Statistical analysis of our data showed no significant correlation between tunnel placement and surgical expertise. However, a highly significant correlation was found (α<0.01) between the femoral position of the tunnel in the sagittal plane and the IKDC score. The more anterior the femoral canal, the poorer the IKDC score. The method of tunnel placement in ACL reconstruction being investigated here only showed slight dependence on surgical experience, whereby good short-term clinical outcomes were achieved. Therefore, the method is suitable for application at a teaching hospital. A far too anterior femoral tunnel placement will probably lead to a decline in the clinical result.
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Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5(3):138–144
Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–S12
Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R, et al (1994) Proceedings of the ESSKA scientific workshop on reconstruction of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 2(3):124–132
Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–21
Deehan DJ, Salmon LJ, Webb VJ, Davies A, Pinczewski LA (2000) Endoscopic reconstruction of the anterior cruciate ligament with an ipsilateral patellar tendon autograft. A prospective longitudinal five-year study. J Bone Joint Surg Br 82(7):984–991
Eichhorn J, Girdano N (2005) Computerassistierte Rekonstruktion des vorderen Kreuzbandes mit dem Navigationssystem. Arthroskopie 18:24–26
Fink C, Hoser C, Rupp S (2005) VKB-Plastik: Positionierung des Transplantates. Arthroskopie 18:15–20
Fink C, Hoser C, Benedetto KP, Hackl W, Gabl M (1996) Langzeitergebnisse nach konservativer oder operativer Therapie der vorderen Kreuzbandruptur. Unfallchirurg 99:964–969
Friederich NF, O’Brien WR (1990) Zur funktionellen anatomie der Kreuzbänder. In: Jakob RP, Stäubli HU (eds) Kniegelenk und Kreuzbänder. Springer, Berlin Heidelberg New York
Fu FH, Bennett CH, Ma CB, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med 28(1):124–130
Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. Am J Sports Med 17(2):208–216
Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13(4):248–255
Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the international knee documentation committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6(2):107–114
Jomha NM, Pinczewski LA, Clingeleffer A, Otto DD (1999) Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years. J Bone Joint Surg Br 81(5):775–779
Kohn D, Busche T, Carls J (1998) Drill hole position in endoscopic anterior cruciate ligament reconstruction. Results of an advanced arthroscopy course. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S13–S15
Lobenhoffer P, Bernard M, Agneskirchner J (2003) Qualitätssicherung in der Kreuzbandchirurgie. Methoden zur Beurteilung der Bohrkanäle bei der vorderen Kreuzbandplastik. Arthroskopie 16:202–208
Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19(3):297–304
Markolf KL, Hame S, Hunter DM, Oakes DA, Zoric B, Gause P, Finerman GA (2002) Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. J Orthop Res 20(5):1016–1024
Müller W (1982). Das Knie. Form, Funktion und ligamentäre Wiederherstellungschirurgie. Springer, Berlin Heidelberg, New York
Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33(5):712–718
Pässler HH, Höher J (2004) Intraoperative Qualitätskontrolle bei der Bohrkanalplatzierung vom vorderen Kreuzbandersatz. Unfallchirurg 107:263–272
Rupp S, Kaltenkirchen N, Hopf T, Gleitz M (1995) Clinical relevance of tunnel position and interference screw location after replacement-plasty of the anterior cruciate ligament with a patellar ligament transplant. Unfallchirurg 98(12):650–654
Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15(2):285–293
Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg Am 85-A(6):1018–1029
Sommer C, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8(4):207–213
Stäubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Knee Surg Sports Traumatol Arthrosc 2:138–146
Topliss C, Webb J (2001) An audit of tunnel position in anterior cruciate ligament reconstruction. Knee 8(1):59–63
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Behrend, H., Stutz, G., Kessler, M.A. et al. Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital. Knee Surg Sports Traumatol Arthrosc 14, 1159–1165 (2006). https://doi.org/10.1007/s00167-006-0186-7
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DOI: https://doi.org/10.1007/s00167-006-0186-7