Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction
Abstract
:1. Introduction
2. Femoral Tunnel Assessments
2.1. Cadaveric Anatomy
2.2. Postoperative 3D CT-Based Study
2.3. Clinical Relevance of Postoperative 3D CT
3. Authors’ Suggestions
4. Conclusions
5. Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Louboutin, H.; Debarge, R.; Richou, J.; Selmi, T.A.S.; Donell, S.T.; Neyret, P.; Dubrana, F. Osteoarthritis in patients with anterior cruciate ligament rupture: A review of risk factors. Knee 2009, 16, 239–244. [Google Scholar] [CrossRef] [PubMed]
- Tuca, M.; Valderrama, I.; Eriksson, K.; Tapasvi, S. Current trends in anterior cruciate ligament surgery. A worldwide benchmark study. J. ISAKOS 2023, 8, 2–10. [Google Scholar] [CrossRef] [PubMed]
- Moran, T.E.; Ignozzi, A.J.; Werner, B.C. Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop. J. Sports Med. 2021, 9, 23259671211035741. [Google Scholar] [CrossRef] [PubMed]
- Vijayan, S.; Kyalakond, H.; Kulkarni, M.S.; Aroor, M.N.; Shetty, S.; Bhat, V.; Rao, S.K. Clinical outcome of anterior cruciate ligament reconstruction with modified transtibial and anteromedial portal. Musculoskelet. Surg. 2021, 107, 37–45. [Google Scholar] [CrossRef]
- Fernandes, T.L.; Moreira, H.H.; Andrade, R.; Sasaki, S.U.; Bernardo, W.M.; Pedrinelli, A.; Espregueira-Mendes, J.; Hernandez, A.J. Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis. Orthop. J. Sports Med. 2021, 9, 23259671211013327. [Google Scholar] [CrossRef]
- Wang, H.; Fleischli, J.E.; Zheng, N.N. Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction: Outcomes of knee joint kinematics during walking. Am. J. Sports Med. 2013, 41, 1847–1856. [Google Scholar] [CrossRef]
- Fox, M.A.; Engler, I.D.; Zsidai, B.T.; Hughes, J.D.; Musahl, V. Anatomic anterior cruciate ligament reconstruction: Freddie Fu’s paradigm. J. ISAKOS 2023, 8, 15–22. [Google Scholar] [CrossRef]
- Musahl, V.; Plakseychuk, A.; VanScyoc, A.; Sasaki, T.; Debski, R.E.; Mcmahon, P.J.; Fu, F.H. Varying femoral tunnels between the anatomical footprint and isometric positions: Effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am. J. Sports Med. 2005, 33, 712–718. [Google Scholar] [CrossRef]
- Zantop, T.; Diermann, N.; Schumacher, T.; Schanz, S.; Fu, F.H.; Petersen, W. Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: Importance of femoral tunnel location on knee kinematics. Am. J. Sports Med. 2008, 36, 678–685. [Google Scholar] [CrossRef]
- Sirleo, L.; Innocenti, M.; Innocenti, M.; Civinini, R.; Carulli, C.; Matassi, F. Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement. Knee Surg. Sports Traumatol. Arthrosc. 2018, 26, 468–477. [Google Scholar] [CrossRef]
- Vermersch, T.; Lustig, S.; Reynaud, O.; Debette, C.; Servien, E.; Neyret, P. CT assessment of femoral tunnel placement after partial ACL reconstruction. Orthop. Traumatol. Surg. Res. 2016, 102, 197–202. [Google Scholar] [CrossRef] [PubMed]
- Tomihara, T.; Hashimoto, Y.; Taniuchi, M.; Shimada, N. Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study. Arch. Orthop. Trauma Surg. 2015, 135, 839–846. [Google Scholar] [CrossRef] [PubMed]
- Vadlamudi, A.; Kale, A.; Sharma, J.; Patil, V.; Pai, M. Comparison of Inside-Out and Outside-In Methods of Femoral Tunnel Preparation in Anterior Cruciate Ligament (ACL) Reconstruction Using 3D-CT. Cureus 2022, 14, e23367. [Google Scholar] [CrossRef] [PubMed]
- Seo, Y.J.; Song, S.Y.; Im, W.Y.; Kim, Y.S.; Jang, S.W. Effects of flexible reamer on the femoral tunnel characteristics in anterior cruciate ligament reconstruction. Medicine 2021, 100, e27833. [Google Scholar] [CrossRef] [PubMed]
- Yoon, K.H.; Kim, J.H.; Kwon, Y.B.; Kim, E.J.; Lee, S.H.; Kim, S.G. A two-portal technique using a flexible reamer system is a safe and effective method for transportal anterior cruciate ligament reconstruction. Arch. Orthop. Trauma Surg. 2020, 140, 383–390. [Google Scholar] [CrossRef]
- Lee, D.W.; Kim, J.G.; Lee, J.H.; Park, J.H.; Kim, D.H. Comparison of Modified Transtibial and Outside-In Techniques in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018, 34, 2857–2870. [Google Scholar] [CrossRef]
- Kim, J.G.; Wang, J.H.; Lim, H.C.; Ahn, J.H. Femoral graft bending angle and femoral tunnel geometry of transportal and outside-in techniques in anterior cruciate ligament reconstruction: An in vivo 3-dimensional computed tomography analysis. Arthroscopy 2012, 28, 1682–1694. [Google Scholar] [CrossRef]
- Youm, Y.S.; Cho, S.D.; Eo, J.; Lee, K.J.; Jung, K.H.; Cha, J.R. 3D CT analysis of femoral and tibial tunnel positions after modified transtibial single bundle ACL reconstruction with varus and internal rotation of the tibia. Knee 2013, 20, 272–276. [Google Scholar] [CrossRef]
- Bird, J.H.; Carmont, M.R.; Dhillon, M.; Smith, N.; Brown, C.; Thompson, P.; Spalding, T. Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 2011, 27, 1259–1267. [Google Scholar] [CrossRef]
- de Abreu-e-Silva, G.M.; Baumfeld, D.S.; Bueno, E.L.; Pfeilsticker, R.M.; de Andrade, M.A.; Nunes, T.A. Clinical and three-dimensional computed tomographic comparison between ACL transportal versus ACL transtibial single-bundle reconstructions with hamstrings. Knee 2014, 21, 1203–1209. [Google Scholar] [CrossRef]
- Niki, Y.; Nagai, K.; Harato, K.; Suda, Y.; Nakamura, M.; Matsumoto, M. Effects of femoral bone tunnel characteristics on graft-bending angle in double-bundle anterior cruciate ligament reconstruction: A comparison of the outside-in and transportal techniques. Knee Surg. Sports Traumatol. Arthrosc. 2017, 25, 1191–1198. [Google Scholar] [CrossRef] [PubMed]
- Parkar, A.P.; Adriaensen, M.; Vindfeld, S.; Solheim, E. The Anatomic Centers of the Femoral and Tibial Insertions of the Anterior Cruciate Ligament: A Systematic Review of Imaging and Cadaveric Studies Reporting Normal Center Locations. Am. J. Sports Med. 2017, 45, 2180–2188. [Google Scholar] [CrossRef] [PubMed]
- Parkar, A.P.; Adriaensen, M.E.; Fischer-Bredenbeck, C.; Inderhaug, E.; Strand, T.; Assmus, J.; Solheim, E. Measurements of tunnel placements after anterior cruciate ligament reconstruction—A comparison between CT, radiographs and MRI. Knee 2015, 22, 574–579. [Google Scholar] [CrossRef]
- Parkar, A.P.; Adriaensen, M.E.; Strand, T.; Inderhaug, E.; Harlem, T.; Solheim, E. How to read post-operative radiographs and CT scans after single-bundle anterior cruciate ligament reconstruction. Skeletal. Radiol. 2013, 42, 1489–1500. [Google Scholar] [CrossRef] [PubMed]
- Colombet, P.; Robinson, J.; Christel, P.; Franceschi, J.-P.; Djian, P.; Bellier, G.; Sbihi, A. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: A cadaveric dissection and radiographic study. Arthroscopy 2006, 22, 984–992. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.K.; Lee, S.; Seong, S.C.; Lee, M.C. Anatomy of the anterior cruciate ligament insertion sites: Comparison of plain radiography and three-dimensional computed tomographic imaging to anatomic dissection. Knee Surg. Sports Traumatol. Arthrosc. 2015, 23, 2297–2305. [Google Scholar] [CrossRef] [PubMed]
- Luites, J.W.; Wymenga, A.B.; Blankevoort, L.; Kooloos, J.G. Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg. Sports Traumatol. Arthrosc. 2007, 15, 1422–1431. [Google Scholar] [CrossRef]
- Tsukada, H.; Ishibashi, Y.; Tsuda, E.; Fukuda, A.; Toh, S. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J. Orthop. Sci. 2008, 13, 122–129. [Google Scholar] [CrossRef]
- Lorenz, S.; Elser, F.; Mitterer, M.; Obst, T.; Imhoff, A.B. Radiologic evaluation of the insertion sites of the 2 functional bundles of the anterior cruciate ligament using 3-dimensional computed tomography. Am. J. Sports Med. 2009, 37, 2368–2376. [Google Scholar] [CrossRef]
- Musahl, V.; Burkart, A.; Debski, R.E.; Van Scyoc, A.; Fu, F.H.; Woo, S.L. Anterior cruciate ligament tunnel placement: Comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system. Arthroscopy 2003, 19, 154–160. [Google Scholar] [CrossRef]
- Forsythe, B.; Kopf, S.; Wong, A.K.; Martins, C.A.; Anderst, W.; Tashman, S.; Fu, F.H. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J. Bone Jt. Surg. Am. 2010, 92, 1418–1426. [Google Scholar] [CrossRef]
- Bernard, M.; Hertel, P.; Hornung, H.; Cierpinski, T. Femoral insertion of the ACL. Radiographic quadrant method. Am. J. Knee Surg. 1997, 10, 14–21, discussion 21–12. [Google Scholar] [PubMed]
- Piefer, J.W.; Pflugner, T.R.; Hwang, M.D.; Lubowitz, J.H. Anterior cruciate ligament femoral footprint anatomy: Systematic review of the 21st century literature. Arthroscopy 2012, 28, 872–881. [Google Scholar] [CrossRef]
- Ferretti, M.; Ekdahl, M.; Shen, W.; Fu, F.H. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: An anatomic study. Arthroscopy 2007, 23, 1218–1225. [Google Scholar] [CrossRef] [PubMed]
- Tsukada, S.; Fujishiro, H.; Watanabe, K.; Nimura, A.; Mochizuki, T.; Mahakkanukrauh, P.; Yasuda, K.; Akita, K. Anatomic variations of the lateral intercondylar ridge: Relationship to the anterior margin of the anterior cruciate ligament. Am. J. Sports Med. 2014, 42, 1110–1117. [Google Scholar] [CrossRef] [PubMed]
- van Eck, C.F.; Martins, C.A.; Vyas, S.M.; Celentano, U.; van Dijk, C.N.; Fu, F.H. Femoral intercondylar notch shape and dimensions in ACL-injured patients. Knee Surg. Sports Traumatol. Arthrosc. 2010, 18, 1257–1262. [Google Scholar] [CrossRef] [PubMed]
- Brown, C.H., Jr.; Spalding, T.; Robb, C. Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int. Orthop. 2013, 37, 253–269. [Google Scholar] [CrossRef]
- Inderhaug, E.; Larsen, A.; Strand, T.; Waaler, P.A.; Solheim, E. The effect of feedback from post-operative 3D CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 2016, 24, 154–160. [Google Scholar] [CrossRef]
- Meuffels, D.E.; Reijman, M.; Verhaar, J.A. Computer-assisted surgery is not more accurate or precise than conventional arthroscopic ACL reconstruction: A prospective randomized clinical trial. J. Bone Jt. Surg. Am. 2012, 94, 1538–1545. [Google Scholar] [CrossRef]
- Mhaskar, V.A.; Jain, Y.; Soni, P.; Fiske, R.; Maheshwari, J. How Important is the Tunnel Position in Outcomes Post-ACL Reconstruction: A 3D CT-Based Study. Indian J. Orthop. 2022, 56, 312–318. [Google Scholar] [CrossRef]
- Parkinson, B.; Robb, C.; Thomas, M.; Thompson, P.; Spalding, T. Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Am. J. Sports Med. 2017, 45, 1529–1536. [Google Scholar] [CrossRef] [PubMed]
- Hosseini, A.; Lodhia, P.; Van de Velde, S.K.; Asnis, P.D.; Zarins, B.; Gill, T.J.; Li, G. Tunnel position and graft orientation in failed anterior cruciate ligament reconstruction: A clinical and imaging analysis. Int. Orthop. 2012, 36, 845–852. [Google Scholar] [CrossRef] [PubMed]
- Marchant, B.G.; Noyes, F.R.; Barber-Westin, S.D.; Fleckenstein, C. Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am. J. Sports Med. 2010, 38, 1987–1996. [Google Scholar] [CrossRef] [PubMed]
- Trojani, C.; Sbihi, A.; Djian, P.; Potel, J.-F.; Hulet, C.; Jouve, F.; Bussière, C.; Ehkirch, F.-P.; Burdin, G.; Dubrana, F.; et al. Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg. Sports Traumatol. Arthrosc. 2011, 19, 196–201. [Google Scholar] [CrossRef] [PubMed]
- Lee, D.W.; Lee, D.H.; Moon, S.G.; Kang, J.H.; Woo, Y.J.; Kim, W.J. Femoral Tunnel Geometry and Graft Inclination Angles in Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System. Medicina 2023, 59, 1031. [Google Scholar] [CrossRef] [PubMed]
- Hagiwara, K.; Terauchi, M.; Hatayama, K.; Yanagisawa, S.; Ohsawa, T.; Kimura, M. Sagittal Inclination Angle of Graft Is Associated With Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction. Arthroscopy 2021, 37, 2533–2541. [Google Scholar] [CrossRef] [PubMed]
- Snoj, Z.; Zupanc, O.; Strazar, K.; Salapura, V. A descriptive study of potential effect of anterior tibial translation, femoral tunnel and anterior cruciate ligament graft inclination on clinical outcome and degenerative changes. Int. Orthop. 2017, 41, 789–796. [Google Scholar] [CrossRef]
- Lee, S.M.; Yoon, K.H.; Lee, S.H.; Hur, D. The Relationship Between ACL Femoral Tunnel Position and Postoperative MRI Signal Intensity. J. Bone Jt. Surg. Am. 2017, 99, 379–387. [Google Scholar] [CrossRef]
- Ahn, J.H.; Jeong, H.J.; Lee, Y.S.; Park, J.H.; Lee, J.H.; Ko, T.S. Graft bending angle is correlated with femoral intraosseous graft signal intensity in anterior cruciate ligament reconstruction using the outside-in technique. Knee 2016, 23, 666–673. [Google Scholar] [CrossRef]
- Magnussen, R.A.; Debieux, P.; Benjamin, B.; Lustig, S.; Demey, G.; Servien, E.; Neyret, P. A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery. Knee Surg. Sports Traumatol. Arthrosc. 2012, 20, 1298–1306. [Google Scholar] [CrossRef]
Study | Whole Bundle | Anteromedial Bundle | Posterolateral Bundle | |||
---|---|---|---|---|---|---|
High to Low (%) | Deep to Shallow (%) | High to Low (%) | Deep to Shallow (%) | High to Low (%) | Deep to Shallow (%) | |
Colombet et al. [25] | 36.5 | 29.4 | 25.3 | 26.4 | 47.6 | 32.3 |
Forsythe et al. [31] | 44.3 | 28.4 | 33.2 | 21.7 | 55.3 | 35.1 |
Lee et al. [26] | 41.0 | 37.3 | 25.6 | 33.9 | 56.4 | 40.6 |
Lorenz et al. [29] | 33.5 | 24.0 | 22.0 | 21.0 | 45.0 | 27.0 |
Luites et al. [27] | 28.5 | 25.5 | 10.0 | 23.0 | 47.0 | 28.0 |
Musahl et al. [30] | 26.6 | 26.3 | Not applicable | Not applicable | Not applicable | Not applicable |
Tsukada et al. [28] | 30.0 | 30.4 | 17.8 | 25.9 | 41.1 | 34.8 |
Femoral Tunnel Type | Location Relative to the Lateral Intercondylar Ridge | |
---|---|---|
I | Well positioned | Inferior and posterior |
II-Vertical | Slightly malpositioned | Overlapping |
II-Anterior | ||
II-Both | ||
III | Significantly malpositioned | Entirely vertical and/or anterior |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kim, M.-J.; Moon, S.-G.; Kang, J.-H.; Lee, D.-W. Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction. Medicina 2023, 59, 1716. https://doi.org/10.3390/medicina59101716
Kim M-J, Moon S-G, Kang J-H, Lee D-W. Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction. Medicina. 2023; 59(10):1716. https://doi.org/10.3390/medicina59101716
Chicago/Turabian StyleKim, Min-Jeong, Sung-Gyu Moon, Ji-Hee Kang, and Dhong-Won Lee. 2023. "Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction" Medicina 59, no. 10: 1716. https://doi.org/10.3390/medicina59101716