2015 ISAKOS Biennial Congress ePoster #1345

Clinical Results of Double-Bundle Transtibial ACL Reconstruction Using a Laser-Assisted Tibial Drill Guide

Yasutake Iseki, MD, Toon, Ehime JAPAN
Toshiaki Takahashi, MD, PhD, Prof., Matsuyama, Ehime JAPAN
Seiji Watanabe, MD, Toon, Ehime JAPAN
Haruhiko Takeda , MD, Toon, Ehime JAPAN
Kazunori Hino, MD, PhD, Toon, Ehime JAPAN
Masami Ishimaru, MD, Toon JAPAN
Yoshio Onishi, MD, Toon, Ehime JAPAN
Hiromasa Miura, MD, PhD, Prof., Toon, Ehime JAPAN

Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, JAPAN

FDA Status Cleared

Summary: Summary We used a laser beam to transtibially select the location of the femoral tunnel during double-bundle ACL reconstruction. Our method using a laser-assisted tibial drill guide is a useful way to accurately select the appropriate anatomical site for the bone tunnel and thus to obtain excellent clinical results in transtibial double-bundle ACL reconstruction.

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Abstract:

Introduction

We developed and produced a tibial drill guide with an associated laser beam that can identify the optimum location of the femoral bone tunnel during the production of the tibial tunnel, and applied it clinically during anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the location of the bone tunnels after double-bundle ACL reconstruction using this laser-assisted tibial drill guide and to examine the anterior instability of the knee with a KT-1000® arthrometer and Lysholm scoring.
Subjects and Methods:
Double-bundle ACL reconstruction using a laser-assisted tibial drill guide was performed in 38 patients (19 males and 19 females) with a mean age of 26.4 years (range, 15 to 58) at a mean postoperative period of 42 months (range, 24 to 61 months).
We used a laser beam to transtibially select the location of the femoral tunnel during ACL reconstruction. This involved setting a laser pointer at the tibial guide; the guide reflected the laser beam and illuminated the point at which the femoral bone tunnel should be made.
Computed tomography (CT) scans were taken within 2 weeks after surgery to evaluate the centers of the bone tunnel positions. Three-dimensional images were used with the quadrant method described by Bernard et al. for the femoral tunnel and with Stäubli’s technique described by Amis and Jakob for the tibial tunnel. Knee joint stability using a KT-1000® arthrometer and Lysholm scores was assessed pre- and postoperatively.
The statistical analysis was performed with paired t tests.

Results

Three-dimensional CT scans indicated that the femoral anteromedial (AM) tunnel apertures were located at mean values of 28.7% (SD, 5.6) along Blumensaat’s line and 24.4% (SD, 8.4) perpendicular to it. These values were 36.7% (SD, 6.9) and 48.8% (SD, 8.0), respectively, for femoral posterolateral (PL) tunnels. AM and PL tunnels were located in the tibia at 36.2% (SD, 7.0) and 50.2% (SD, 6.6) relative to the Amis-Jakob line.
Arthrometric measurements showed that the mean side-to-side difference was 4.95 mm (SD, 2.0) preoperatively and 0.5 mm (SD, 1.0) at a mean of 42 months postoperatively (P<0.00001).
The mean Lysholm score was 71.2 points (SD, 12.7) preoperatively and 98.8 points (SD, 2.2) at final follow-up (P<0.00001).

Discussion

While the conventional transtibial method may have the disadvantage of inaccurate tunnel placement, the surgical technique is simple and widely established. To resolve the problem of location, a laser-guided technique to identify the placement of tibial and femoral attachment was used in a clinical setting. The optimum location of the femoral tunnel was indicated by a laser beam while the center of the bone tunnel in the tibia was simultaneously selected. The present method made it possible to create a bone tunnel located at the anatomical site of the AM and PL bundles in both the femur and tibia.

Conclusions

Our method is a useful way to accurately select the appropriate anatomical site for the bone tunnel and thus to obtain excellent clinical results in transtibial double-bundle ACL reconstruction.