Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: Do different anatomic reconstruction techniques create similar femoral tunnels?

Jae Gyoon Kim, Minho Chang, Hong Chul Lim, Ji Hoon Bae, Jin Hwan Ahn, Joon Ho Wang

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22 Citations (Scopus)

Abstract

Background: The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. Purpose: To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. Results: The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). Conclusion: The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. Clinical Relevance: The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to consider the shallower PL femoral tunnel positions created with the OI technique.

Original languageEnglish
Pages (from-to)2512-2520
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume41
Issue number11
DOIs
Publication statusPublished - 2013 Nov 1

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Anterior Cruciate Ligament Reconstruction
Thigh
Tomography

Keywords

  • anterior cruciate ligament reconstruction
  • aperture shape
  • femoral tunnel position
  • outside-in
  • transportal
  • tunnel position

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{adef4e6ed7d24f41ab4060175d1ab954,
title = "Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: Do different anatomic reconstruction techniques create similar femoral tunnels?",
abstract = "Background: The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. Purpose: To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. Results: The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). Conclusion: The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. Clinical Relevance: The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to consider the shallower PL femoral tunnel positions created with the OI technique.",
keywords = "anterior cruciate ligament reconstruction, aperture shape, femoral tunnel position, outside-in, transportal, tunnel position",
author = "Kim, {Jae Gyoon} and Minho Chang and Lim, {Hong Chul} and Bae, {Ji Hoon} and Ahn, {Jin Hwan} and Wang, {Joon Ho}",
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TY - JOUR

T1 - Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction

T2 - Do different anatomic reconstruction techniques create similar femoral tunnels?

AU - Kim, Jae Gyoon

AU - Chang, Minho

AU - Lim, Hong Chul

AU - Bae, Ji Hoon

AU - Ahn, Jin Hwan

AU - Wang, Joon Ho

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background: The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. Purpose: To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. Results: The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). Conclusion: The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. Clinical Relevance: The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to consider the shallower PL femoral tunnel positions created with the OI technique.

AB - Background: The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. Purpose: To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. Results: The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). Conclusion: The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. Clinical Relevance: The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to consider the shallower PL femoral tunnel positions created with the OI technique.

KW - anterior cruciate ligament reconstruction

KW - aperture shape

KW - femoral tunnel position

KW - outside-in

KW - transportal

KW - tunnel position

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