2015 ISAKOS Biennial Congress ePoster #1333

Clinical Results of a New All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction Technique with Minimum 1-Year Follow-Up

Seiji Watanabe, MD, Toon, Ehime JAPAN
Toshiaki Takahashi, MD, PhD, Prof., Matsuyama, Ehime JAPAN
Kazunori Hino, MD, PhD, Toon, Ehime JAPAN
Masami Ishimaru, MD, Toon JAPAN
Yoshio Onishi, MD, Toon, Ehime JAPAN
Tatsuhiko Kutsuna, MD, PhD, 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

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use:

Summary: We created a drill guide pin and a reamer, and clinically applied a new all-inside double-bundle ACL reconstruction technique in addition to our already developed laser-guided device for the transtibial approach. Using this procedure, we obtained anatomically appropriate positions of both AM and PL tunnels, and excellent stability of the knee and favorable short-term clinical results.

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Abstract:

Background

All-inside anterior cruciate ligament (ACL) reconstruction has been shown to reduce postoperative pain; however, this technique is technically complex and demanding. We created a drill guide pin and a reamer, and established and clinically applied a new all-inside double-bundle ACL reconstruction technique in addition to our already developed laser-guided device for the transtibial approach. The purpose of this study was to evaluate this new surgical procedure in terms of bone tunnel location and short-term clinical results.

Methods

and Subjects: The reamer in our method was located in the central portion of the guide pin. This unique design enabled the surgeon to create both femoral and tibial sockets in a single step, and also allowed for the precise determination of tibial socket length. Our utilization of a laser-guided drilling system and the combination of newly developed drill guide pins and reamers can assist the surgeon in performing the all-inside technique in a straightforward and robust manner.
This double-bundle ACL reconstruction procedure was performed in 24 patients (14 males and 10 females) with a mean age of 29.9 years. Anterior and posterior tibial translation were measured using an arthrometer (KT-1000®) and Lysholm scores both preoperatively and at a mean of 24.9 months (range, 13 to 37) postoperatively. Computed tomography (CT) scans were performed to evaluate bone tunnel positions in three dimensions using the quadrant method described by Bernard et al. for the femoral tunnel and Stäubli’s technique as described by Amis and Jakob for the tibial tunnel.
The statistical analysis was performed with paired t tests to detect any differences between the preoperative and final follow-up side-to-side differences of arthrometric measurements and Lysholm scores.

Results

Arthrometric measurements (n=23) showed that the mean side-to-side differences were 5.3 (SD, 1.5) mm preoperatively and 0.05 (SD, 0.7) mm at a mean of 24.9 months postoperatively, indicating remarkable improvement (P<0.00001). The mean Lysholm scores were 56.6 (SD, 14.7) preoperatively and 95.0 (SD, 3.7) at final follow-up, demonstrating significant improvement (n=22) (P<0.00001).
CT scans indicated that the femoral anteromedial (AM) tunnel apertures were located at mean values of 29.1% (SD, 7.1) along, and 25.0% (SD, 7.9) perpendicular to, Blumensaat’s line. These values were 37.3% (SD, 6.7) and 49.5% (SD, 10.7), respectively, for the femoral posterolateral (PL) tunnels. In the tibia, AM and PL tunnels were located at 39.9% (SD, 4.3) and 52.7% (SD, 6.1) relative to Amis and Jakob’s line. These results demonstrated that both AM and PL tunnels were placed at anatomically appropriate positions. No treatment-related complications were observed.

Discussion

and Conclusions: The advantages of this method include easy and accurate determination of the intraarticular distance and socket lengths, and comparatively simplified and straightforward bone hole preparation. Our method helps the surgeon place femoral and tibial tunnels at anatomically correct positions. Using this procedure, we obtained excellent stability of the knee and favorable short-term clinical results. This approach may provide an alternative option for all-inside ACL reconstruction. Further studies with a large number of patients and long-term follow-up are required.