Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction
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Purpose: The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions requiredto prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods: The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results: In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion: The techniquefor double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.
Abstract
Purpose: The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions requiredto prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods: The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results: In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion: The techniquefor double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.
참고문헌 (30)
- Gianotti SM, "Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study", J Sci Med Sport, 12, pp.622~627 (2009)
- Muller B, "Indications and contraindications for double-bundle ACL reconstruction", Int Orthop, 37, pp.239~246 (2013)
- Schreiber VM, "Anatomic Double-bundle ACL Reconstruction", Sports Med Arthrosc, 18, pp.27~32 (2010)
- Fu FH, "Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study", Am J Sports Med, 36, pp.1263~1274 (2008)
- Mae T, "Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator", Arthroscopy, 17, pp.708~716 (2001)
- Muneta T, "A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques", Arthroscopy, 23, pp.618~628 (2007)
- Yagi M, "Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction", Am J Sports Med, 30, pp.660~666 (2002)
- Yasuda K, "Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures", Arthroscopy, 22, pp.240~251 (2006)
- Neven E, "Double-bundle anterior cruandciate ligament reconstruction: a cadaveric study on the posterolateral tunnel position and safety of the lateral structures", Arthroscopy, 24, pp.436~440 (2008)
- Tsukada H, "Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints", J Orthop Sci, 13, pp.122~129 (2008)
- Hantes ME, "Evaluation of the bone bridge between the bone tunnels after anatomic double-bundle anterior cruciate ligament reconstruction: a multidetector computed tomography study", Am J Sports Med, 38, pp.1618~1625 (2010)
- Christel P, "Anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers", Arthroscopy, 24, pp.1146~1151 (2008)
- Pombo MW, "Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today?", Arthroscopy, 24, pp.1168~1177 (2008)
- Zantop T, "Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings", Am J Sports Med, 36, pp.65~72 (2008)
- Petersen W, "Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels", Am J Sports Med, 35, pp.228~234 (2007)
- Steckel H, "The double-bundle technique for anterior cruciate ligament reconstruction: a systematic overview", Scand J Med Sci Sports, 17, pp.99~108 (2007)
- Lind M, "Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop", Arthroscopy, 25, pp.1275~1280 (2009)
- Wilson TC, "Tunnel enlargement after anterior cruciate ligament surgery", Am J Sports Med, 32, pp.543~549 (2004)
- Basdekis G, "Effect of knee flexion angle on length and orientation of posterolateral femoral tunnel drilled through anteromedial portal during anatomic double-bundle anterior cruciate ligament reconstruction", Arthroscopy, 25, pp.1108~1114 (2009)
- Lehmann AK, "Femoral bridge stability in double-bundle ACL reconstruction:impact of bridge width and different fixation techniques on the structural properties of the graft", femur complex, 2009, pp.129, 1127~1132
- Chae IJ, "Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint: Technical note with clinical results", Archives of Orthopaedic and Trauma Surgery, 133(6), pp.819~825 (2013), Springer Verlag
- Tajima T, "Arthroscopic anatomical double-bundle anterior cruciate ligament reconstruction for asian patient using a bone-patellar tendon-bone and gracilis tendon composite autograft: a technical note", Sports Med Arthrosc Rehabil Ther Technol, 4, pp.9~ (2012)
- Bernard M, "Femoral insertion of the ACL. Radiographic quadrant method", Am J Knee Surg, 10, pp.14~21 (1997)
- Hensler D, "Medial portal drilling: effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction", J Bone Joint Surg Am, 93, pp.2063~2071 (2011)
- Lee YS, "Analysis of tunnel widening after double-bundle ACL reconstruction", KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 20(11), pp.2243~2250 (2012), SPRINGER
- Clatworthy MG, "Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts", Knee Surg Sports Traumatol Arthrosc, 7, pp.138~145 (1999)
- Ahn JH, "Femoral bioabsorbable cross-pin fixation in anterior cruciate ligament reconstruction", Arthroscopy, 23, pp.1093~1099 (2007)
- L’Insalata JC, "Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts", Knee Surg Sports Traumatol Arthrosc, 5, pp.234~238 (1997)
- Siebold R, "Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study", Arthroscopy, 26, pp.1066~1073 (2010)
- Järvelä T, "Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study", Arthroscopy, 24, pp.1349~1357 (2008)