KS2: FEMORAL TUNNEL PLACEMENT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Abstract

There is significant disagreement among surgeons regarding optimal placement of the femoral tunnel for anterior cruciate ligament reconstruction. Placement of the femoral tunnel via a transtibial approach usually will not allow consistent overlap between the tunnel and the anterior cruciate ligament footprint. This remains true in recent publications in spite of the fact that the tunnel center lay totally outside the femoral footprint.

We have performed radiographic studies (Feller et al, 1993), cadaveric studies (Kaseta et al 2008) and currently postoperative studies showing that femoral tunnel creation is much more anatomic with an independent drilling technique. We have performed postoperative high resolution MRI exams of both knees using a protocol that reliably shows the anterior cruciate ligament footprint on the normal knee and the tunnel on the surgical knees. The centers are approximately 2mm. apart for independent techniques and 9mm. apart of the transtibially created tunnels.

We are now using dual angle fluoroscopy and high resolution MRI mapping to evaluate the in vivo kinematics of knees following anterior cruciate ligament reconstruction with independent or transtibial techniques.