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Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction

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Abstract

In anterior cruciate ligament (ACL) reconstruction, transtibial drilling of the femoral tunnel has been criticized for its vertical and less anatomical tunnel, which accompanied rotational instability of knee. Many authors recommend anteromedial (AM) portal drilling technique, which creates more oblique and anatomic femoral tunnel. However, recent researches show that oblique tunnel is related to risks of too short femoral tunnel, blowout of back wall, and posterolateral structures injury. Is oblique femoral tunnel really essential for anatomic reconstruction? We introduce a modified AM technique, which abandons the oblique tunnel and provides vertical femoral tunnel and oblique graft with anatomic starting point. The fundamental of the new technique is that oblique graft but not oblique tunnel is essential for rotational stability of knee. Thus, it avoids the risks and preserves anatomic reproduction of ACL.

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References

  1. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23(1):7–13 PMID: 17210421

    Article  PubMed  Google Scholar 

  2. Harner CD, Honkamp NJ, Ranawat AS (2008) Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 24(1):113–115 PMID: 18188873

    Article  PubMed  Google Scholar 

  3. Steiner ME, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M (2009) Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 37(10):1912–1919 PMID: 19729364

    Article  PubMed  Google Scholar 

  4. Jepsen CF, Lundberg-Jensen AK, Faunoe P (2007) Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament–reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy 23(12):1326–1333 PMID: 18063177

    Article  PubMed  Google Scholar 

  5. Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25(1):95–101 PMID: 19111224

    Article  PubMed  Google Scholar 

  6. Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD (2007) The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy 23(11):1187–1192 PMID: 17986406

    Article  PubMed  Google Scholar 

  7. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ III (2010) Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy 26(3):342–350 PMID: 20206044

    Article  PubMed  Google Scholar 

  8. Chang CB, Yoo JH, Chung BJ, Seong SC, Kim TK (2010) Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med 38(6):1237–1245 PMID: 20348283

    Article  PubMed  Google Scholar 

  9. Gelber PE, Reina F, Torres R, Pelfort X, Tey M, Monllau JC (2010) Anatomic single-bundle anterior cruciate ligament reconstruction from the anteromedial portal: evaluation of transverse femoral fixation in a cadaveric model. Arthroscopy 26(5):651–657 PMID: 20434663

    Article  PubMed  Google Scholar 

  10. Xu H, Zhang C (2010) Can coronal oblique angel be translated to clock-face position in femoral tunnel preparation of anterior cruciate ligament reconstruction? Arthroscopy 26(12):1566–1568 PMID: 21112474

    Article  PubMed  Google Scholar 

  11. van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26(2):258–268 PMID: 20141990

    Article  PubMed  Google Scholar 

  12. Forsythe B, Kopf S, Wong AK, Martins CAQ, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels of anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92(6):1418–1426 PMID: 20516317

    Article  PubMed  Google Scholar 

  13. Lee MC, Seong SC, Lee S, Chang CB, Park YK, Jo H, Kim CH (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23(7):771–778 PMID: 17637414

    Article  PubMed  Google Scholar 

  14. 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. 2002 Richard O’Connor Award paper. Arthroscopy 19(3):297–304

    Article  PubMed  Google Scholar 

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The patients in this case report were informed that data of their case would be submitted for publication and they agreed to this.

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Authors and Affiliations

  1. Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, People’s Republic of China

    Chunli Zhang, Hu Xu, Xiaojian Li, Yingchun Wang, Qiang Zhang & Qinsheng Zhu

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  1. Chunli Zhang
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  2. Hu Xu
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  3. Xiaojian Li
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  4. Yingchun Wang
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  5. Qiang Zhang
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  6. Qinsheng Zhu
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Correspondence to Hu Xu.

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Zhang, C., Xu, H., Li, X. et al. Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction. Eur J Orthop Surg Traumatol 23, 731–735 (2013). https://doi.org/10.1007/s00590-012-1046-4

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  • DOI: https://doi.org/10.1007/s00590-012-1046-4

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