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Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study

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

Abstract

Purpose

Femoral tunnel angle (FTA) has been proposed as a metric for evaluating whether ACL reconstruction was performed anatomically. In clinic, radiographic images are typically acquired with an uncertain amount of internal/external knee rotation. The extent to which knee rotation will influence FTA measurement is unclear. Furthermore, differences in FTA measurement between the two common positions (0° and 45° knee flexion) have not been established. The purpose of this study was to investigate the influence of knee rotation on FTA measurement after ACL reconstruction.

Methods

Knee CT data from 16 subjects were segmented to produce 3D bone models. Central axes of tunnels were identified. The 0° and 45° flexion angles were simulated. Knee internal/external rotations were simulated in a range of ±20°. FTA was defined as the angle between the tunnel axis and femoral shaft axis, orthogonally projected into the coronal plane.

Results

Femoral tunnel angle was positively/negatively correlated with knee rotation angle at 0°/45° knee flexion. At 0° knee flexion, FTA for anterio-medial (AM) tunnels was significantly decreased at 20° of external knee rotation. At 45° knee flexion, more than 16° external or 19° internal rotation significantly altered FTA measurements for single-bundle tunnels; smaller rotations (±9° for AM, ±5° for PL) created significant errors in FTA measurements after double-bundle reconstruction.

Conclusion

Femoral tunnel angle measurements were correlated with knee rotation. Relatively small imaging malalignment introduced significant errors with knee flexed 45°. This study supports using the 0° flexion position for knee radiographs to reduce errors in FTA measurement due to knee internal/external rotation.

Level of evidence

Case–control study, Level III.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Jing Tang, Eric Thorhauer, Chelsea Marsh & Freddie H. Fu

  2. Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, 31 Xinjiekou Dongjie St., Beijing, 100035, China

    Jing Tang

  3. Orthopedic Research Laboratories, University of Pittsburgh, 3820 South Water St., Pittsburgh, PA, 15203, USA

    Scott Tashman

Authors
  1. Jing Tang
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  2. Eric Thorhauer
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  3. Chelsea Marsh
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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.

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Tang, J., Thorhauer, E., Marsh, C. et al. Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study. Knee Surg Sports Traumatol Arthrosc 22, 1505–1510 (2014). https://doi.org/10.1007/s00167-013-2504-1

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  • DOI: https://doi.org/10.1007/s00167-013-2504-1

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