Influence of femoral tunnel exit on the 3D graft bending angle in anterior cruciate ligament reconstruction

被引:6
作者
Hodel, Sandro [1 ]
Mania, Sylvano [1 ]
Vlachopoulos, Lazaros [1 ]
Furnstahl, Philipp [2 ]
Fucentese, Sandro F. [1 ]
机构
[1] Univ Zurich, Balgrist Univ Hosp, Dept Orthoped, Forchstr 340, CH-8008 Zurich, Switzerland
[2] Univ Zurich, Univ Hosp Balgrist, Res Orthoped Comp Sci ROCS, Forchstr 340, CH-8008 Zurich, Switzerland
关键词
ACL; Anterior cruciate ligament; Graft bending angle; GBA; Femoral tunnel; OUTSIDE-IN; FAILURE; BUNDLE; LENGTH; FIXATION;
D O I
10.1186/s40634-021-00364-9
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose To quantify the influence of the femoral tunnel exit (FTE) on the graft bending angle (GBA) and GBA-excursion throughout a full range of motion (ROM) in single-bundle anterior cruciate ligament (ACL) reconstruction. Methods Three-dimensional (3D) surface models of five healthy knees were generated from a weight-bearing CT obtained throughout a full ROM (0, 30, 60, 90, 120 degrees) and femoral and tibial ACL insertions were computed. The FTE was simulated for 16 predefined positions, referenced to the Blumensaat's line, for each patient throughout a full ROM (0, 30, 60, 90, 120 degrees) resulting in a total of 400 simulations. 3D GBA was calculated between the 3D directional vector of the ACL and the femoral tunnel, while the intra-articular ACL insertions remained unchanged. For each simulation the 3D GBA, GBA-excursion, tunnel length and posterior tunnel blow-out were analysed. Results Overall, mean GBA decreased with increasing knee flexion for each FTE (p < 0.001). A more distal location of the FTE along the Blumensaat's line resulted in an increase of GBA and GBA-excursion of 8.5 +/- 0.6 degrees and 17.6 +/- 1.1 degrees /cm respectively (p < 0.001), while a more anterior location resulted in a change of GBA and GBA-excursion of -2.3 +/- 0.6 degrees /cm (+ 0.6 +/- 0.4 degrees/ cm from 0-60 degrees flexion) and 9.8 +/- 1.1 /cm respectively (p < 0.001). Mean tunnel length was 38.5 +/- 5.2 mm (range 29.6-50.5). Posterior tunnel blow-out did not occur for any FTE. Conclusion Aiming for a more proximal and posterior FTE, with respect to Blumensaat's line, reliably reduces GBA and GBA-excursion, while preserving adequate tunnel length. This might aid to reduce excessive graft stress at the femoral tunnel aperture, decrease femoral tunnel widening and promote graft-healing.
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页数:8
相关论文
共 35 条
[1]   Graft bending angle is correlated with femoral intraosseous graft signal intensity in anterior cruciate ligament reconstruction using the outside-in technique [J].
Ahn, Jin Hwan ;
Jeong, Hwa Jae ;
Lee, Yong Seuk ;
Park, Jai Hyung ;
Lee, Jin Ho ;
Ko, Taeg Su .
KNEE, 2016, 23 (04) :666-673
[2]  
Bernard M, 1996, UNFALLCHIRURG, V99, P332
[3]  
BESL PJ, 1992, P SOC PHOTO-OPT INS, V1611, P586, DOI 10.1117/12.57955
[4]  
Biggs Angie, 2009, N Am J Sports Phys Ther, V4, P2
[5]   Femoral insertion site in medial patellofemoral ligament reconstruction [J].
Blatter, Samuel C. ;
Fuernstahl, Philipp ;
Hirschmann, Anna ;
Graf, Matthias ;
Fucentese, Sandro F. .
KNEE, 2016, 23 (03) :456-459
[6]   Hamstring Graft Incorporation According to the Length of the Graft Inside Tunnels [J].
Cavaignac, Etienne ;
Marot, Vincent ;
Faruch, Marie ;
Reina, Nicolas ;
Murgier, Jerome ;
Accadbled, Franck ;
Berard, Emilie ;
Chiron, Philippe .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2018, 46 (02) :348-356
[7]   Graft bending angle affects allograft tendon maturity early after anterior cruciate ligament reconstruction [J].
Chen, Linhai ;
Wu, Yibing ;
Lin, Guanghao ;
Wei, Peng ;
Ye, Zaohui ;
Wang, Yangjian ;
Ren, Tiantian .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2018, 26 (10) :3048-3054
[8]   The "Ligamentization" Process in Anterior Cruciate Ligament Reconstruction What Happens to the Human Graft? A Systematic Review of the Literature [J].
Claes, Steven ;
Verdonk, Peter ;
Forsyth, Ramses ;
Bellemans, Johan .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2011, 39 (11) :2476-2483
[9]  
Cohen J., 1969, STAT POWER ANAL BEHA
[10]   Incorporation of Hamstring Grafts Within the Tibial Tunnel After Anterior Cruciate Ligament Reconstruction Magnetic Resonance Imaging of Suspensory Fixation Versus Interference Screws [J].
Colombet, Philippe ;
Graveleau, Nicolas ;
Jambou, Stephane .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2016, 44 (11) :2838-2845