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The effects of limb alignment on anterior cruciate ligament graft tunnel positions estimated from plain radiographs

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aims of this study were (1) to evaluate the femoral tunnel position after anatomic double-bundle and nonanatomic single-bundle reconstruction; (2) to evaluate the influence of rotation of the femur caused by limb malalignment on measurements of the position of the femoral ACL tunnel aperture relative to Blumensaat’s line.

Methods

3D CT scans were performed in 5 patients after anatomic double-bundle reconstruction and 5 patients after nonanatomic single-bundle reconstruction. Digitally reconstructed lateral radiographs were generated from the 3D CT scans to determine the tunnel position on the femur along and perpendicular to Blumensaat’s line. The femur was then rotated to simulate internal/external and varus/valgus rotations from 0° to 15° in 5° increments. At each rotated bone position, tunnel position relative to Blumensaat’s line was calculated and the difference from the lateral radiograph was calculated.

Results

After double-bundle reconstruction, the AM tunnel was located at 31.5 (±5.0) % along Blumensaat’s line and 29.7 (±13.6) % perpendicular to Blumensaat’s line, and the PL tunnel at 36.2 (±12.9) % along Blumensaat’s line and 34.2 (±7.6) % perpendicular to Blumensaat’s line. Valgus greater than 10° significantly affected the assessment of tunnel position (P = 0.043). After nonanatomic single-bundle reconstruction, the tunnel position was 35.4 (±15.0) % along Blumensaat’s line and −2.7 (±19.4) % perpendicular to Blumensaat’s line. Internal rotation of more than 10° significantly affected the assessment of tunnel position (P = 0.043).

Conclusions

Tunnel position after anatomic double-bundle reconstruction and nonanatomic single-bundle reconstruction can be determined on lateral radiographs. However, valgus and internal rotation of more than 10° can introduce significant errors in tunnel position estimates.

Level of evidence

Case series, Level IV.

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Acknowledgments

The Authors wish to thank Mike Tranovich and Zachri Buzzinotti for the help with the statistical analysis of the data and helpful discussion. The authors did not receive any outside funding or grants directly related to the research presented in this manuscript. The research that forms the basis for this manuscript was done at our institution. Our institution receives a research grant from Smith and Nephew to support research related to ACL reconstruction.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Research Laboratories, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA, 15203, USA

    Carola F. van Eck, Andrew K. Wong, J. J. Irrgang, Freddie H. Fu & Scott Tashman

  2. Department of Orthopaedic Surgery, Orthopaedic Research Centre Amsterdam, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands

    Carola F. van Eck

Authors
  1. Carola F. van Eck
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  2. Andrew K. Wong
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  3. J. J. Irrgang
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  4. Freddie H. Fu
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  5. Scott Tashman
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Corresponding author

Correspondence to Scott Tashman.

Additional information

This study was approved by our institutional research board.

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van Eck, C.F., Wong, A.K., Irrgang, J.J. et al. The effects of limb alignment on anterior cruciate ligament graft tunnel positions estimated from plain radiographs. Knee Surg Sports Traumatol Arthrosc 20, 979–985 (2012). https://doi.org/10.1007/s00167-011-1683-x

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  • DOI: https://doi.org/10.1007/s00167-011-1683-x

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