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The Knee Joint pp 183–194Cite as

Tunnels, graft positioning, and isometry in ACL reconstruction

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Abstract

This chapter deals with ideal placement of tibial and femoral bone tunnels, and hence the graft, in single-bundle ACL reconstructions. Double-bundle techniques and the use of navigation to aid tunnel placement are dealt with elsewhere.

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References

  1. Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6 (Suppl 1): S2–S12

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. Sapega AA, Moyer RA, Scheneck C, Komalaharanya N (1990) Testing for isometry during reconstruction of the anterior cruciate ligament: anatomical and biomechanical considerations. J Bone Joint Surg Am 72:259–267

    PubMed  CAS  Google Scholar 

  4. Amis AA, Dawkins GPC (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73-B:260–267

    Google Scholar 

  5. Gabriel MT, Wong EK, Woo S L-Y, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in reponse to rotatory loads. J Orthop Res 22:85–89

    Article  PubMed  Google Scholar 

  6. Harner CD, Hyun Baek G, Vogrin TM, et al. (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15(7):741–749

    Article  PubMed  CAS  Google Scholar 

  7. Bylski-Austrow DI, Grood ES, Hefzy MS, et al. (1990) Anterior cruciate ligament replacements: a mechanical study of femoral attachment location, flexion angle at tensioning and initial tension. J Orthop Res 8(4):522–531

    Article  PubMed  CAS  Google Scholar 

  8. Hefzy MS, Grood ES (1986) Sensitivity of insertion locations on length patterns of anterior cruciate ligament fibres. J Biomech Eng 108(1):73–82

    Article  PubMed  CAS  Google Scholar 

  9. Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of the most isometric femoral attachment. Part 2: Th e anterior cruciate ligament. Am J Sports Med 17(2):108–216

    Article  Google Scholar 

  10. Cooper DE, Urrea L, Small J (1998) Factors affecting isometry of endoscopic anterior cruciate ligament reconstruc tion: the effect of guide offset and rotation. Arthroscopy 1998 14(2):164–70

    Article  PubMed  CAS  Google Scholar 

  11. Garofalo R, Moretti B, Kombot C, et al. (2007) Femoral tunnel placement in anterior cruciate ligament reconstruction: a rationale of the two incision technique. J Orthop Surg 2:10

    Article  Google Scholar 

  12. Clancy WG, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg Am 64(3):352–359

    PubMed  Google Scholar 

  13. Howell SM, Taylor MA (1993) Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg Am 75(7):1044–1055

    PubMed  CAS  Google Scholar 

  14. Jackson DW, Schaefer RK (1990) Cyclops syndrome; loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178

    Article  PubMed  CAS  Google Scholar 

  15. Watanabe BM, Howell SM (1995) Arthroscopic fi ndings associated with roof impingement of an anterior cruciate ligament graft. Am J Sports Med 23:616–625

    Article  PubMed  CAS  Google Scholar 

  16. Goss BC, Hull ML, Howell SM (1997) Contact pressure and tension in anterior cruciate ligament grafts subjected to roof impingement during passive extension. J Orthop Res 15:263–268

    Article  PubMed  CAS  Google Scholar 

  17. Howell SM, Lawhorn KW (2004) Gravity reduces the tibia when using a tibial guide that targets the intercondylar roof. Am J Sports Med 32:1702–1710

    Article  PubMed  Google Scholar 

  18. Markolf KL, Hame SL, Monte Hunter D, et al. (2002) Biomechanical effects of femoral notchplasty in anterior cruciate ligament reconstruction. Am J Sports Med 30(1):83–89

    PubMed  Google Scholar 

  19. Aglietti P, Buzzi R, Giron F, et al. (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8 year follow-up. Knee Surg Traumatol Arthrosc 5:138–144

    Article  CAS  Google Scholar 

  20. LaPrade RB, Terry GC, Montgomery RD, et al. (1998) The effects of aggressive notchplasty on the normal knee in dogs. Am J Sports Med 26:193–200

    Article  PubMed  CAS  Google Scholar 

  21. Fu FH, Bennett CH, Ma CB, et al. (2000) Current trends in anterior cruciate ligament reconstruction: Part 2. Operative procedures and clinical correlations. Am J Sports Med 28:124–130

    PubMed  CAS  Google Scholar 

  22. Hame SL, Markolf KL, Monte Hunter D, et al. (2003) Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Arthroscopy 19(4):340–345

    Article  PubMed  Google Scholar 

  23. Howell SM, Clark JA, Farley TE (1991) A rationale for predicting anterior cruciate graft impingement by the intercondylar roof: a magnetic resonance study. Am J Sports Med 19(3):276–282

    Article  PubMed  CAS  Google Scholar 

  24. Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg 67A:257–262

    Google Scholar 

  25. Howell SM, Clark JA (1990) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195

    Google Scholar 

  26. Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Kneev Surg Sports Traumatol Arthrosc 6(Suppl 1): S49–S55

    Article  Google Scholar 

  27. Howell SM, Berns GS, Farley TE (1991) Unimpinged and impinged anterior cruciate ligament grafts: MR signal intensity measurements. Radiology 179:639–643

    PubMed  CAS  Google Scholar 

  28. Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288

    Article  PubMed  CAS  Google Scholar 

  29. Simmons R, Howell SM, Hull ML (2003) Effects of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg Am 85A(6):1018–1029

    Google Scholar 

  30. Romano VM, Graf BK, Keene JS, Langhe RH (1993) Anterior cruciate ligament reconstruction. Th e effect of tibial tunnel placement on range of motion. Am J Sports Med 21:415–418

    Article  PubMed  CAS  Google Scholar 

  31. Howell SM, Gittins ME, Gottlieb JE, et al. (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of fl exion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29:567–574

    PubMed  CAS  Google Scholar 

  32. Jackson DW, Gasser SI (1994) Tibial tunnel placement in ACL reconstruction. Arthroscopy 10:124–131

    Article  PubMed  CAS  Google Scholar 

  33. Buzzi R, Zaccherotti G, Giron F, Aglietti P (1999) The relationship between the intercondylar roof and the tibial plateau with the knee in extension: relevance for tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 15:625–631

    Article  PubMed  CAS  Google Scholar 

  34. Howell SM, Barad SJ (1995) Knee extension and its relationship to the slope of the intercondylar roof: implications for positioning the tibial tunnel in anterior cruciate ligament reconstruction. Am J Sports Med 23:288–294

    Article  PubMed  CAS  Google Scholar 

  35. Cuomo P, Edwards A, Giron F, et al. (2006) Validation of the 65° Howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22(1):70–75

    Article  PubMed  Google Scholar 

  36. Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9(4):194–199

    PubMed  CAS  Google Scholar 

  37. Loh JC, Fukuda Y, Tsuda E, et al. (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19(3):297–304

    Article  PubMed  Google Scholar 

  38. Mae T, Shino K, Miyama T, et al. (2001) Single versus twofemoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716

    Article  PubMed  CAS  Google Scholar 

  39. Markolf KL, Hame S, Monte Hunter D, et al. (2002) Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. J Orthop Res 20:1016–1024

    Article  PubMed  Google Scholar 

  40. Musahl V, Plakseychuk A, VanScyoc A, et al. (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect of kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33(5):712–718

    Article  PubMed  Google Scholar 

  41. Scopp JM, Jasper LE, Belkoff SM, Moorman CT (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20(3):294–299

    Article  PubMed  Google Scholar 

  42. Woo SL, Kanamori A, Zeminski J, et al. (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84-A(6):907–914

    PubMed  Google Scholar 

  43. Yagi M, Wong EK, Kanamori A, et al. (2002) The biomechanical analysis of anatomical ACL reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  44. Chul Lee M, Cheol Seong S, Lee S, et al. (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23(7):771–778

    Article  Google Scholar 

  45. Khalfayan EE, Sharkey PF, Alexander AH, et al. (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24:335–341

    Article  PubMed  CAS  Google Scholar 

  46. Pinczewski LA, Salmon LJ, Jackson WFM, et al. (2008) Radiological landmarks for placement of the tunnels in single bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 90-B:172–179

    Article  Google Scholar 

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Authors
  1. A. Williams
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  2. N. Devic
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© 2012 Springer-Verlag France, Paris

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Williams, A., Devic, N. (2012). Tunnels, graft positioning, and isometry in ACL reconstruction. In: The Knee Joint. Springer, Paris. https://doi.org/10.1007/978-2-287-99353-4_16

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  • DOI: https://doi.org/10.1007/978-2-287-99353-4_16

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-99352-7

  • Online ISBN: 978-2-287-99353-4

  • eBook Packages: MedicineMedicine (R0)

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