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Open Access Research article

A quantitative technique to create a femoral tunnel at the averaged center of the anteromedial bundle attachment in anatomic double-bundle anterior cruciate ligament reconstruction

Shuken Kai1, Eiji Kondo1*, Nobuto Kitamura1, Yasuyuki Kawaguchi1, Masayuki Inoue2, Andrew A Amis3 and Kazunori Yasuda1

Author Affiliations

1 The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan

2 The Department of Orthopaedic Surgery, NTT East Japan Sapporo, Sapporo, Hokkaido, Japan

3 The Department of Mechanical Engineering, Imperial College London, London, England, United Kingdom

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BMC Musculoskeletal Disorders 2013, 14:189  doi:10.1186/1471-2474-14-189

Published: 15 June 2013

Abstract

Background

In the anatomic double-bundle ACL reconstruction, 2 femoral tunnel positions are particularly critical to obtain better clinical results. Recently, a few studies have reported quantitative identification methods for posterolateral (PL) bundle reconstruction. Concerning anteromedial (AM) bundle reconstruction, however, no quantitative clinically available methods to insert a guide wire at the center of the direct attachment of the AM mid-substance fibers have been reported to date.

Methods

First, we determined the center of the femoral attachment of the AM mid-substance fibers using 38 fresh frozen cadaveric knees. Based on this anatomical sub-study, we developed a quantitative clinical technique to insert a guide wire at the averaged center for anatomic double-bundle ACL reconstruction. In the second clinical sub-study with 63 patients who underwent anatomic ACL reconstruction with this quantitative technique, we determined the center of an actually created AM tunnel. Then, we compared the results of the second sub-study with those of the first sub-study to validate the accuracy of the quantitative technique. In both the sub-studies, we determined the center of the anatomical attachment and the tunnel outlet using the “3-dimensional clock” system. The tunnel outlet was evaluated using the “transparent” 3-dimensional computed tomography.

Results

The averaged center of the direct attachment of the AM bundle midsubstance fibers was located on the cylindrical surface of the femoral intercondylar notch at “10:37” (or “1:23”) o’clock orientation in the distal view and at 5.0-mm from the proximal outlet of the intercondylar notch (POIN) in the lateral view. The AM tunnel actually created in ACL reconstruction was located at “10:41” (or “1:19”) o’clock orientation in the average and at 5.0-mm from the POIN. There was no significant difference between the 2 center locations.

Conclusions

The quantitative technique enabled us to easily create the femoral AM tunnel at the averaged center of the direct attachment of the AM bundle midsubstance fibers with high accuracy. This study reported information on the geometric location of the femoral attachment of the AM bundle and a clinically useful technique for its anatomical reconstruction.

Keywords:
Anterior cruciate ligament; Anatomic reconstruction; Anteromedial bundle; Femoral tunnel; Footprint attachment location