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Impingement following anterior cruciate ligament reconstruction: comparing the direct versus indirect femoral tunnel position

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

Abstract

Purpose

During anterior cruciate ligament (ACL) reconstruction, authors have suggested inserting the femoral tunnel at the biomechanically relevant direct fibres, but this higher position can cause more impingement. Therefore, we aimed to assess ACL graft impingement at the femoral notch for ACL reconstruction at both the direct and indirect tunnel positions.

Methods

A virtual model was created for twelve cadaveric knees with computed tomography scanning in which a virtual graft was placed at direct and indirect tunnel positions of the anteromedial bundle (AM), posterolateral bundle (PL) or centre of the both bundles (C). In these six tunnel positions, the volume (mm3) and mid-point location of impingement (°) were measured at different flexion angles.

Results

Generally, more impingement was seen with the indirect position compared with the direct position although this was only significant at 90° of flexion for the AM position (97 ± 28 vs. 76 ± 20 mm3, respectively; p = 0.046). The direct tunnel position impinged higher at the notch, whereas the indirect position impinged more towards the lateral wall, but this was only significant at 90° of flexion for the AM (24 ± 5° vs. 34 ± 4°, respectively; p < 0.001) and C position (34 ± 5° vs. 42 ± 5°, respectively; p = 0.003).

Conclusion

In this cadaveric study, the direct tunnel position did not cause more impingement than the indirect tunnel position. Based on these results, graft impingement is not a limitation to reconstruct the femoral tunnel at the insertion of the biomechanically more relevant direct fibres.

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Acknowledgments

The authors wish to thank Joseph Lipman from the Division of Devise Development (Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA) for his valuable assistance in preparing the figures of this paper. Furthermore, the authors wish to thank Carl Imhauser for his valuable assistance in performing the measurements.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA

    J. P. van der List, H. A. Zuiderbaan, D. H. Nawabi & A. D. Pearle

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  1. J. P. van der List
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Correspondence to J. P. van der List.

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van der List, J.P., Zuiderbaan, H.A., Nawabi, D.H. et al. Impingement following anterior cruciate ligament reconstruction: comparing the direct versus indirect femoral tunnel position. Knee Surg Sports Traumatol Arthrosc 25, 1617–1624 (2017). https://doi.org/10.1007/s00167-015-3897-9

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