Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction:an in vivo study

Abstract

【Abstract】Objective: To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction. Methods: Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45° and 55° to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. Af ter the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached gainst the lateral wall of intercondylar notch. The position that the reamer shaf t can reach was marked and recorded. Results: Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation thr ough the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24 %) the femoral AM tunnel opening and in 0 cases ( 20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel. Conclusion: The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized. Key words: Anterior cruciate ligament reconstr uction; Arthroscopy; Anatomy; Knee