2015 ISAKOS Biennial Congress ePoster #1371

Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction with Rounded Rectangle Femoral Tunnel

Junsuke Nakase, MD, PhD, Kanazawa, Ishikawa JAPAN
Tatsuhiro Toratani, MD, Kanazawa, Ishikawa JAPAN
Masahiro Kosaka, MD, Kanazawa, Ishikawa JAPAN
Yoshinori Ohashi, MD, Kanazawa, Ishikawa JAPAN
Hitoaki Numata, MD, Kanazawa, Ishikawa JAPAN
Takeshi Oshima, MD, PhD, Sydney, NSW AUSTRALIA
Hiroyuki Tsuchiya, Kanazawa, Ishikawa JAPAN

Kanazawa university hospital, Kanazawa, JAPAN

FDA Status Not Applicable

Summary: We present a new single-bundle anterior cruciate ligament (ACL) reconstruction technique which is based on the fact that the both cross-section of the quadruple semitendinosus muscle tendon and the femoral insertion of the ACL are oval. We developed an original rounded rectangular dilator set to create rounded rectangular femoral tunnels whose shape matches the shape of the harvested graft and ins

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Abstract:

Purpose

This study aimed to present a new technique for single-bundle anterior cruciate ligament (ACL). The technique is based on the fact that both the cross-section of the quadruple semitendinosus muscle tendon and the femoral insertion of the ACL are oval shaped. We developed an original rounded rectangular dilator set to create rounded rectangular femoral tunnels that would mimic ACL femoral insertion.
Technique: The presented technique is single-bundle ACL reconstruction using a semitendinosus graft (with or without the gracilis tendon). The size of the femoral tunnel was decided depending on the size of the harvested graft. The tunnel was drilled via an additional medial portal. Rounded rectangular tunnels were created using a special dilator. The tunnel positions were confirmed using medial portal arthroscopy and intraoperative X-ray examination. Tibial tunnels were created using conventional rounded tunnels. Fixation was achieved using a suspensory device on the femoral side and a plate and screw on the tibial side.
Patients: Thirty-five patients underwent this surgery, and intraoperative complications were investigated. The femoral tunnel positions were documented postoperatively from computed tomography scans using the quadrant method. The tibial tunnel positions (anterior-to-posterior, medial-to-lateral) were documented using intraoperative X-ray scans.

Results

Only 1 patient had a posterior tunnel wall blowout. The femoral tunnel length varied between 30 and 40 mm (mean, 35.4 ± 3.3 mm). No neurological or vascular deficits or breakage of the guide wire was noted. Difficulty with graft passage was documented in 2 cases. All femoral and tibial tunnels were located within the area of the anatomical ACL insertions.

Conclusion

We present a new single-bundle ACL reconstruction technique, wherein the shape of the rounded rectangular femoral tunnels created match the shape of the harvested graft and insertion site anatomy.