Abstract
Abstract
Background
Performing lateral extra-articular tenodesis (LET) with ACL reconstruction may conflict with the ACLR femoral tunnel.
Methods
12 fresh-frozen cadaveric knees were used: at 120 flexion, an 8mm ACLR femoral tunnel was drilled in the anteromedial bundle position via the anteromedial portal. A modified Lemaire LET was performed using a 1 cm-wide iliotibial band strip left attached to Gerdy's tubercle. The LET femoral fixation point was identified 10mm proximal / 5 mm posterior to the LCL femoral attachment, and a 2.4-mm guide wire was drilled, aiming at 0, 10, 20, or 30 degrees anteriorly in the axial plane, and at 0, 10, or 20 degrees proximally in the coronal plane. The relationship between the LET drilling guide wire and the ACLR femoral tunnel reamer was recorded for each combination. When collision with the femoral tunnel was recorded, the LET wire depth was measured.
Results
Tunnel conflict occurred at a mean LET wire depth of 23.6 mm (15–33 mm). No correlation existed between LET wire depth and LET drilling orientation (r=0.066; p=0.67). Drilling angle in the axial plane was significantly associated with the occurrence of tunnel conflict (P < .001). However, no such association was detected when comparing the drilling angle in the coronal plane (P=0.267).
Conclusion
Conflict occurred at as little as 15 mm depth. When longer implants are used, the orientation should be at least 30 degrees anterior in the axial plane.
Clinical Relevance
This study provides important information for surgeons performing LET in combination with ACLR.
