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A modified transtibial technique to achieve an anatomical position of the femoral tunnel for anterior cruciate ligament reconstruction
Arthrosc Orthop Sports Med 2019;6:18-24
Published online May 1, 2019;  https://doi.org/10.14517/aosm19001
© 2019 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Yeon Seok Jeong, In Taek Oh, Jung Yun Choi

Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Correspondence to: Jung Yun Choi, https://orcid.org/0000-0001-6652-7380, Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea. Tel: +82-2- 950-1114, Fax: +82-2-950-1429, E-mail: cjyortho@hanmail.net
Received January 21, 2019; Revised April 2, 2019; Accepted April 29, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: To evaluate the anatomical locations of the femoral and tibial tunnels using a modified transtibial anterior cruciate ligament (ACL) reconstruction technique and to assess clinical and functional outcomes over a 2-year follow-up period.
Methods: Between January 2012 and October 2016, 50 patients (50 knees) treated with a novel, modified transtibial ACL reconstruction technique were retrospectively reviewed. Tibial tunnels were serially corrected with a pusher to recreate the anatomical position of the femoral tunnel. Both tunnel positions were evaluated using three-dimensional reconstructions of computed tomography images. Functional outcomes were preoperatively and postoperatively evaluated using the International Knee Documentation Committee (IKDC) and Lysholm scores, with clinical outcomes evaluated using the Lachman, pivot shift, and Telos stress tests.
Results: The center of the femoral tunnel was positioned at 31.4% ± 5.9% from the posterior to anterior direction parallel to Blumensaat’s line and 36.1% ± 9.0% from the superior to inferior direction perpendicular to Blumensaat’s line. The center of the tibial tunnel was positioned at 39.2% ± 7.5% from the anterior to posterior direction of the tibial plateau and 46.6% ± 3.1% from medial to lateral direction. Compared with previous cadaveric studies, the femoral tunnel was located closer to the posterolateral bundle and the tibial tunnel was located posteriorly. The IKDC and Lysholm scores increased from 64.4 ± 11.1 and 72.2 ± 12.8 preoperatively to 93.5 ± 5.3 and 96.0 ± 3.2 at 2 years, respectively. Except for one, all cases were postoperatively negative on the Lachman and pivot shift tests. The Telos stress test result also improved from 6.0 ± 5.0 mm to 1.4 ± 1.4 mm.
Conclusion: Our modified transtibial ACL reconstruction technique was effective for localizing the femoral tunnel closer to the anatomical footprint of the ACL and achieved good clinical outcomes.
Keywords : Orthopedic procedures; Anterior cruciate ligament reconstruction
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