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Dugas JR, Pace JL, Bolt B, et al. Evaluation and Comparison of Femoral Tunnel Placement During Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography: Effect of Notchplasty on Transtibial and Medial Portal Drilling. Orthop J Sports Med. 2014;2(3):2325967114525572doi: 10.1177/2325967114525572.
Dugas, J. R., Pace, J. L., Bolt, B., Wear, S. A., Beason, D. P., & Cain, E. L. (2014). Evaluation and Comparison of Femoral Tunnel Placement During Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography: Effect of Notchplasty on Transtibial and Medial Portal Drilling. Orthopaedic journal of sports medicine, 2(3), 2325967114525572. https://doi.org/10.1177/2325967114525572
Dugas, Jeffrey R, et al. "Evaluation and Comparison of Femoral Tunnel Placement During Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography: Effect of Notchplasty on Transtibial and Medial Portal Drilling." Orthopaedic journal of sports medicine vol. 2,3 (2014): 2325967114525572. doi: https://doi.org/10.1177/2325967114525572
Dugas JR, Pace JL, Bolt B, Wear SA, Beason DP, Cain EL. Evaluation and Comparison of Femoral Tunnel Placement During Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography: Effect of Notchplasty on Transtibial and Medial Portal Drilling. Orthop J Sports Med. 2014 Mar 05;2(3):2325967114525572. doi: 10.1177/2325967114525572. eCollection 2014 Mar. PMID: 26535307; PMCID: PMC4555567.
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Orthop J Sports Med. 2014 Mar 05;2(3):2325967114525572. doi: 10.1177/2325967114525572. eCollection 2014 Mar.

Evaluation and Comparison of Femoral Tunnel Placement During Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography: Effect of Notchplasty on Transtibial and Medial Portal Drilling.

Orthopaedic journal of sports medicine

Jeffrey R Dugas, Jesse L Pace, Becky Bolt, Shane A Wear, David P Beason, E Lyle Cain

Affiliations

  1. American Sports Medicine Institute, Birmingham, Alabama, USA.
  2. Radiology Associates Birmingham, Birmingham, Alabama, USA.

PMID: 26535307 PMCID: PMC4555567 DOI: 10.1177/2325967114525572

Abstract

BACKGROUND: Advocates of medial portal drilling claim that the transtibial technique results in a more vertical positioning of the graft, which could lead to subsequent failure and/or a residual pivot shift on postoperative examination. However, advocates of transtibial drilling state that with appropriate placement and adequate notchplasty, their technique places the graft in a more anatomically correct position on the wall, negating the resultant potential for pivot shift and early postoperative failure.

HYPOTHESIS: Transtibial femoral drilling can adequately reproduce the femoral origin of the anterior cruciate ligament (ACL) and place the graft in an anatomical position equivalent to medial portal drilling.

STUDY DESIGN: Controlled laboratory study.

METHODS: Ten matched-pair cadaveric knees (N = 20) were scanned using computed tomography (CT), and 3-dimensional images of the native ACL origin were reconstructed. The matched pairs were then randomized into transtibial and medial portal groups. The femoral tunnel was drilled in each knee according to group. A bamboo skewer was placed in the femoral tunnel, and the knees underwent a second CT scan. Arthroscopic notchplasty was performed, and the femoral tunnels were redrilled. Radiographs confirmed placement, and the post-notchplasty tunnel was reamed with a 4-mm reamer. The knees underwent a third CT scan. CT scans compared femoral tunnel placement with the native ACL footprint before and after notchplasty.

RESULTS: The post-notchplasty transtibial group revealed an average of 68.3% coverage of the native ACL femoral origin. The medial portal group revealed an average of 60.8% coverage, with 1 instance of perforation of the posterior cortex. There were no instances of perforation in the transtibial group.

CONCLUSION: Both drilling techniques place the graft in an anatomically correct position.

CLINICAL RELEVANCE: Transtibial drilling of the femur can adequately place the entry tunnel at the origin of the ACL's native footprint.

Keywords: anterior cruciate ligament; femoral tunnel; medial portal; transtibial

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