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Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling—a 3D and finite element analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Recent studies have emphasized the importance of anatomical ACL reconstruction to restore normal knee kinematics and stability. Aim of this study is to evaluate and compare the ability of the anteromedial (AM) and transtibial (TT) techniques for ACL reconstruction to achieve anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces within the graft during functional motion. As the AM technique is nowadays the technique of choice, the hypothesis is that there are significant differences in tunnel features, reaction forces and/or moments within the graft when compared to the TT technique.

Methods

Twenty ACL-deficient patients were allocated to reconstruction surgery with one of both techniques. Postoperatively, all patients underwent a computed tomography scan (CT) allowing 3D reconstruction to analyze tunnel geometry and tunnel placement within the native ACL footprint. A patient-specific finite element analysis (FEA) was conducted to determine reaction forces and moments within the graft during antero-posterior translation and pivot-shift motion.

Results

With significantly shorter femoral tunnels (p < 0.001) and a smaller inter-tunnel angle (p < 0.001), the AM technique places tunnels with less variance, close to the anatomical centre of the ACL footprints when compared to the TT technique. Using the latter, tibial tunnels were more medialised (p = 0.007) with a higher position of the femoral tunnels (p = 0.02). FEA showed the occurrence of higher, but non-significant, reaction forces in the graft, especially on the femoral side and lower, however, statistically not significant, reaction moments using the AM technique.

Conclusion

This study indicates important, technique-dependent differences in tunnel features with changes in reaction forces and moments within the graft.

Level of evidence

II.

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Funding

No funding was received for this study

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Thomas Tampere, Wouter Devriendt, Michiel Cromheecke, Matthias Verstraete & Jan Victor

  2. Department of Orthopaedic Surgery, AZ Delta, Brugsesteenweg 90, 8800, Roeselare, Belgium

    Thomas Luyckx

Authors
  1. Thomas Tampere
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  2. Wouter Devriendt
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  3. Michiel Cromheecke
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  4. Thomas Luyckx
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  5. Matthias Verstraete
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  6. Jan Victor
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Corresponding author

Correspondence to Thomas Tampere.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethical committee of the University Hospital of Ghent (EC UZG 2012/324–2013/375 - B670201317506).

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Tampere, T., Devriendt, W., Cromheecke, M. et al. Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling—a 3D and finite element analysis. Knee Surg Sports Traumatol Arthrosc 27, 2568–2576 (2019). https://doi.org/10.1007/s00167-018-5272-0

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  • DOI: https://doi.org/10.1007/s00167-018-5272-0

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