Effect of femoral tunnel position on graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament reconstruction
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- 作者：Hideyuki Koga (1)
Takeshi Muneta (1)
Kazuyoshi Yagishita (1)
Toshifumi Watanabe (1)
Tomoyuki Mochizuki (1)
Masafumi Horie (1)
Tomomasa Nakamura (1)
Ichiro Sekiya (1) - 关键词：Double ; bundle ; Anterior cruciate ligament (ACL) reconstruction ; Graft tension ; Tunnel position
- 刊名：Knee Surgery, Sports Traumatology, Arthroscopy
- 出版年：2014
- 出版时间：November 2014
- 年：2014
- 卷：22
- 期：11
- 页码：2811-2820
- 全文大小：827 KB
- 参考文献：1. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86:515-20
2. Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108-13 CrossRef
3. Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260-67
4. Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602-09 CrossRef
5. Bach JM, Hull ML, Patterson HA (1997) Direct measurement of strain in the posterolateral bundle of the anterior cruciate ligament. J Biomech 30:281-83 CrossRef
6. Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14-1 discussion 21-12
7. Colombet P, Robinson J, Christel P et al (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984-92 CrossRef
8. Conner CS, Morris RP, Vallurupalli S, Buford WL Jr, Ivey FM (2008) Tensioning of anterior cruciate ligament hamstring grafts: comparing equal tension versus equal stress. Arthroscopy 24:1323-329 CrossRef
9. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218-225 CrossRef
10. Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85-9 CrossRef
11. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216-31 CrossRef
12. Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37:2386-391 CrossRef
13. Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741-49 CrossRef
14. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226-34 CrossRef
15. Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II: the anterior cruciate ligament. Am J Sports Med 17:208-16 CrossRef
16. Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19:931-35 CrossRef
17. Inoue M, Tokuyasu S, Kuwahara S et al (2010) Tunnel location in transparent 3-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique. Knee Surg Sports Traumatol Arthrosc 18:1176-183 Yagishita (1)
Toshifumi Watanabe (1)
Tomoyuki Mochizuki (1)
Masafumi Horie (1)
Tomomasa Nakamura (1)
Ichiro Sekiya (1)
1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan - ISSN：1433-7347
文摘
Purpose To evaluate the effect of the femoral tunnel position of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) on the graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Methods Forty-five patients who underwent anatomic double-bundle ACL reconstruction were included. AMB and PLB were provisionally fixed to a graft tensioning system in the following settings during surgery: (1) AMB at 20° and PLB at 0° (A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45° (A20P45). Bundle tension was recorded during knee flexion–extension. A pivot shift test was also evaluated. Femoral tunnel positions of the AMB and PLB were then assessed by three-dimensional computed tomography, and the correlation between femoral tunnel position and tension change pattern or residual pivot shift was evaluated. Results The depth of the PLB tunnel position was correlated with the extent of tension reduction in the PLB between 0° and 30° irrespective of graft fixation settings, while neither the AMB tunnel position nor the height of the PLB tunnel position affected the tension change pattern. Ten cases showed grade 1 pivot shift only in the A20P0 setting. The PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases (27.5?±?6.2 and 34.1?±?5.5?%, respectively, P?=?0.002). Conclusions In anatomic double-bundle reconstruction, deeper PLB tunnel position was correlated with the larger tension reduction in the PLB between 0° and 30°. Fixation of the AMB at 20° and the PLB at 0° resulted in residual pivot shift phenomenon in 10/45 cases, and the PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases. In anatomic double-bundle reconstruction, the placement of PLB femoral tunnel must not be too deep, as it might lead to significant tension reduction in the PLB near extension and thus insufficient tension in the PLB, resulting in residual pivot shift phenomenon. Level of evidence IV.