LO SCALPELLO-OTODI Educational

, Volume 30, Issue 2, pp 68–75 | Cite as

Ricostruzione del LCA: confronto radiografico fra tecnica trans-tibiale modificata e tecnica antero-mediale

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LCA reconstruction: radiographic comparison between modified trans-tibial and antero-medial technique

Abstract

Purpose of this study is to compare radiographic findings of two homogeneous groups of athletes after anterior cruciate ligament (ACL) reconstruction, with two different techniques: the modified trans-tibial approach (TTM) and the antero-medial approach (AM). 50 patients, recruited by inclusion criteria, were randomly assigned in two groups (TTM and AM). In TTM group, the tibial tunnel position was slightly modified according to previous studies, in order to attempt at a more anatomic femoral tunnel. The angle and the position of the femoral tunnel were then digitally measured on antero-posterior (AP) and latero-lateral (LL) X-rays. The AM technique produced more horizontal femoral tunnels on frontal plane \((p<0.01)\). This, according to previous studies, is affecting the rotational stability of the knee and can provide better rotational stability. Clinical series evaluated on this topic provided variable differences and our series is under current clinical and functional evaluation.

Notes

Conflitto di interesse

Gli autori A.F. Cheli, F. Soldati, M. Buda, L. Osti dichiarano di non aver alcun conflitto di interesse.

Conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche.

Consenso informato

Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Bibliografia

  1. 1.
    Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ (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 CrossRefPubMedGoogle Scholar
  2. 2.
    Seon JK, Park SJ, Lee KB, Seo HY, Kim MS, Song EK (2011) In vivo stability and clinical comparison of anterior cruciate ligament reconstruction using low or high femoral tunnel positions. Am J Sports Med 39:127–133 CrossRefPubMedGoogle Scholar
  3. 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 37:1912–1919 CrossRefPubMedGoogle Scholar
  4. 4.
    Miller CD, Gerdeman AC, Hart JM et al. (2011) A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction. Arthroscopy 27:372–379 CrossRefPubMedGoogle Scholar
  5. 5.
    Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE (2004) Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med 32:1825–1832 CrossRefPubMedGoogle Scholar
  6. 6.
    Scopp JM, Jasper LE, Belkoff SM, Moorman CT III (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20:294–299 CrossRefPubMedGoogle Scholar
  7. 7.
    Harner CD, Honkamp NJ, Ranawat AS (2008) Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 24:113–115 CrossRefPubMedGoogle Scholar
  8. 8.
    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 19:297–304 CrossRefPubMedGoogle Scholar
  9. 9.
    Arnold MP, Verdonschot N, van Kampen A (2005) ACL graft can replicate the normal ligament’s tension curve. Knee Surg Sports Traumatol Arthrosc 13:625–631 CrossRefPubMedGoogle Scholar
  10. 10.
    Georgoulis AD, Papadonikolakis A, Papageorgiou CD, Mitsou A, Stergiou N (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31:75–79 CrossRefPubMedGoogle Scholar
  11. 11.
    Papannagari R, Gill TJ, Defrate LE, Moses JM, Petruska AJ, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012 CrossRefPubMedGoogle Scholar
  12. 12.
    Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983 CrossRefPubMedGoogle Scholar
  13. 13.
    Csizy M, Friederich NF (2002) Bohrkanallokalisation in der operativen Rekonstruktion des vorderen Kreuzbandes. Position-Fehlplatzierung-Anatomometrie. Orthopaede 31:741–750 CrossRefGoogle Scholar
  14. 14.
    Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II: the anterior cruciate ligament. Am J Sports Med 17:208–216 CrossRefPubMedGoogle Scholar
  15. 15.
    Klos TV, Harman MK, Habets RJ, Devilee RJ, Banks SA (2000) Locating femoral graft placement from lateral radiographs in anterior cruciate ligament reconstruction: a comparison of 3 methods of measuring radiographic images. Arthroscopy 16:499–504 CrossRefPubMedGoogle Scholar
  16. 16.
    Musahl V, Plakseychuk A, Van Scyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718 CrossRefPubMedGoogle Scholar
  17. 17.
    Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17(3):220–227 CrossRefPubMedGoogle Scholar
  18. 18.
    Wagner LR, Thillemann TM, Mehnert F, Pedersen A, Lind M (2012) Increased risk of ACL revision after anteromedial compared with transtibial technique for femoral drillhole placement during ACL reconstruction. Result from the Danish registry of knee ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(Suppl 1):1–3 Google Scholar
  19. 19.
    Riboh JC, Hasselblad V, Godin JA, Mather RC 3rd (2013) Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 41(11):2693–2702 CrossRefPubMedGoogle Scholar
  20. 20.
    Franceschi F, Papalia R, Rizzello G, Del Buono A, Maffulli N, Denaro V (2013) Anteromedial portal versus transtibial drilling techniques in anterior cruciate ligament reconstruction: any clinical relevance? A retrospective comparative study. Arthroscopy 29(8):1330–1337 CrossRefPubMedGoogle Scholar
  21. 21.
    Tudisco C, Bisicchia S (2012) Drilling the femoral tunnel during ACL reconstruction: transtibial versus anteromedial portal techniques. Orthopedics 35(8):1166–1172 CrossRefGoogle Scholar
  22. 22.
    Pascual-Garrido C, Swanson BL, Swanson KE (2012) Transtibial versus low anteromedial portal drilling for anterior cruciate ligament reconstruction: a radiographic study of femoral tunnel position. Knee Surg Sports Traumatol Arthrosc 21(4):846–850 CrossRefPubMedGoogle Scholar
  23. 23.
    Georgoulis A, Tokis A, Bernard M, Paessler H (2005) The anteromedial portal for drilling of the femoral tunnel for anterior cruciate ligament reconstruction. Tech Orthop 20:228–229 CrossRefGoogle Scholar
  24. 24.
    Rue J-P, Ghodadra N, Bach BR (2008) Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament. Am J Sports Med 36(1):73–79 CrossRefPubMedGoogle Scholar
  25. 25.
    Chhabra A, Diduch DR, Blessey PB, Miller MD (2004) Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external land-marks. Arthroscopy 20:328–330 CrossRefPubMedGoogle Scholar
  26. 26.
    Piasecki DP, Bach BR Jr, Espinoza Orias AA, Verma NN (2011) Anterior cruciate ligament reconstruction: can anatomic femoral placement be achieved with a transtibial technique? Am J Sports Med 39(6):1306–1315 CrossRefPubMedGoogle Scholar
  27. 27.
    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 CrossRefPubMedGoogle Scholar
  28. 28.
    Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29(5):567–574 CrossRefPubMedGoogle Scholar
  29. 29.
    Silva A, Sampaio R, Pinto E (2012) ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc 20(5):896–903 CrossRefPubMedGoogle Scholar
  30. 30.
    Rue JP, Ghodadra N, Lewis PB, Bach BR Jr (2008) Femoral and tibial tunnel position using a transtibial drilled anterior cruciate ligament reconstruction technique. J Knee Surg 21(3):246–249 CrossRefPubMedGoogle Scholar
  31. 31.
    Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18(9):1245–1251 CrossRefPubMedGoogle Scholar
  32. 32.
    Gougoulias N, Khanna A, Griffiths D, Maffulli N (2008) ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 15(6):486–490 CrossRefPubMedGoogle Scholar
  33. 33.
    Howell SM, Hull ML (2009) Checkpoints for judging tunnel and anterior cruciate ligament graft placement. J Knee Surg 22:161–170 CrossRefPubMedGoogle Scholar
  34. 34.
    Illingworth KD, Hensler D, Working ZM, Macalena JA, Tashman S, Fu FH, Macalena JA et al. (2011) A simple evaluation of anterior cruciate ligament femoral tunnel position: the inclination angle and femoral tunnel angle. Am J Sports Med 39:2611–2618 CrossRefPubMedGoogle Scholar
  35. 35.
    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 23:7–13 CrossRefPubMedGoogle Scholar
  36. 36.
    Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25(1):95–101 CrossRefPubMedGoogle Scholar
  37. 37.
    Ilahi OA, Ventura NJ, Qadeer AA (2012) Femoral tunnel length: accessory anteromedial portal drilling versus transtibial drilling. Arthroscopy 28(4):486–491. Epub 2012 Jan 20 CrossRefPubMedGoogle Scholar
  38. 38.
    Miller MD, Gerdeman AC, Miller CD, Hart JM, Gaskin CM, Golish SR, Clancy WG Jr (2010) The effects of extra-articular starting point and transtibial femoral drilling on the intra-articular aperture of the tibial tunnel in ACL reconstruction. Am J Sports Med 38(4):707–712 CrossRefPubMedGoogle Scholar
  39. 39.
    Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602–609 CrossRefPubMedGoogle Scholar
  40. 40.
    Noh HK, Wang JH, Bada LP, Ahn JH, Yoo JC, Nha KW, Lee YS (2008) Transtibial anterior cruciate ligament double bundle reconstruction technique: two tibial bundle in one tibial tunnel. Arch Orthop Trauma Surg 128:1245–1250 CrossRefPubMedGoogle Scholar
  41. 41.
    Steiner ME (2008) Evaluation and management of ACL injuries. In: McKeon B, Bono J, Richmond J (eds) Knee arthroscopy. Springer, New York Google Scholar
  42. 42.
    Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35(10):1708–1715. Epub 2007 Jul 30 CrossRefPubMedGoogle Scholar
  43. 43.
    Segawa H, Koga Y, Omori G, Sakamoto M, Hara T (2003) Influence of the femoral tunnel location and angle on the contact pressure in the femoral tunnel in anterior cruciate ligament reconstruction. Am J Sports Med 31(3):444–448 CrossRefPubMedGoogle Scholar
  44. 44.
    Wang JH, Kim JG, Lee do K, Lim HC, Ahn JH (2012) Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(8):1584–1589 CrossRefPubMedGoogle Scholar
  45. 45.
    Chhabra A, Kline AJ, Nilles KM, Harner CD (2006) Tunnel expansion after anterior cruciate ligament reconstruction with autogenous hamstrings: a comparison of the medial portal and transtibial techniques. Arthroscopy 22(10):1107–1112 CrossRefPubMedGoogle Scholar
  46. 46.
    Youm YS, Cho SD, Lee SH, Youn CH (2014) Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med 42(12):2941–2947 CrossRefPubMedGoogle Scholar
  47. 47.
    Xu Y, Liu J, Kramer S, Martins C, Kato Y, Linde-Rosen M, Smolinski P, Fu FH (2011) Comparison of in situ forces and knee kinematics in anteromedial and high anteromedial bundle augmentation for partially ruptured anterior cruciate ligament. Am J Sports Med 39:272–278 CrossRefPubMedGoogle Scholar
  48. 48.
    Howell SM, Hull M, McAllister D (2012) Be sensible and cautious about criticizing tunnel placement in ACL reconstruction. J Bone Jt Surg 133(1):2–3 Google Scholar
  49. 49.
    Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40(9):1985–1992 CrossRefPubMedGoogle Scholar
  50. 50.
    Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘isolated’ anterior cruciate ligament rupture. J Bone Jt Surg, Br Vol 94(5):630–637 CrossRefGoogle Scholar
  51. 51.
    Chalmers PN, Mall NA, Cole BJ, Verma NN, Bush-Joseph CA, Bach BR Jr (2013) Anteromedial versus transtibial tunnel drilling in anterior cruciate ligament reconstructions: a systematic review. Arthroscopy 29(7):1235–1242 CrossRefPubMedGoogle Scholar
  52. 52.
    Giron F, Buzzi R, Aglietti P (1999) Femoral tunnel position in anterior cruciate ligament reconstruction using three techniques. A cadaver study. Arthroscopy 15:750–756 CrossRefPubMedGoogle Scholar
  53. 53.
    Howell SM, Taylor MA (1993) Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Jt Surg, Am Vol 75(7):1044–1055 CrossRefGoogle Scholar
  54. 54.
    Smith CK, Howell SM, Hull ML (2011) Anterior laxity, slippage, and recovery of function in the first year after tibialis allograft anterior cruciate ligament reconstruction. Am J Sports Med 39(1):78–88. Epub 2010 Oct 7 CrossRefPubMedGoogle Scholar
  55. 55.
    Tudisco C, Bisicchia S, Cosentino A, Chiozzi F, Piva M (2015) Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques. Muscles Ligaments Tendons J 205(3):175–180 Google Scholar

Copyright information

© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2016

Authors and Affiliations

  1. 1.Department of Orthopaedics and Trauma SurgeryUniversity Hospital of FerraraFerraraItalia
  2. 2.Unit of Arthroscopy and Sports MedicineHesperia HospitalModenaItalia

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