2017 ISAKOS Biennial Congress ePoster #1147
Accuracy Of Femoral Offset Aimer For Single Bundle Quadrpled Hamstring Anterior Cruciate Ligament Reconstruction Using Transportal Technique
Bharath R. Ramesh, DNB, Bangalore, Karnataka INDIA
Subra K N Subramanian, MBBS,MS,MRCSEd,M.ChOrth,FRCS Orth,CCTOrth(UK), Madurai, Tamil Nadu INDIA
Apollo Hospital, Madurai, Tamil Nadu, INDIA
FDA Status Not Applicable
Summary
Use of a femoral offset aimer helps to precisely position the tunnel for anatomic anterior cruciate ligament reconstruction with ease and reproducible even when landmarks are obscured without much error even in an arthroscopic surgeon in early phase of training giving higher chances of success.
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Abstract
Background
Precise femoral tunnel placement is essential for reproducing normal biomechanics of the knee during anterior cruciate ligament (ACL) reconstruction. Conventionally the entry point is the intersection of lateral intercondylar and bifurcate ridge. Identifying this can be a challenge in early stages of training. Femoral offset aimer is a simple method to perform and overcome the challenge.
Objective
The compare the conventional and femoral aimer techniques in placing the femoral tunnel and to assess the percentage of variation.
Materials And Methods
Thirty four knees from January to May 2015 were studied. The patients underwent ACL reconstruction by transportal technique. Arthroscopic marking was performed where anatomical ACL tunnel is supposed to be. The 6mm offset femoral aimer was used with knee in 120degree flexion at around 10 or 2 ‘o’ clock. The gap between both the points was measured. Tibial tunnel and graft placement with Hamstring graft were done in the usual way.Lysholm score and IKDC score was done in all patients pre-operatively and post operatively at 1,3 and 6 months
Discussion
On measurement, the distance between the mark made and the area drilled using the commercially available femoral aimers showed no variation in 72% of cases, 20.5% of cases had 1 – 2 mm variation in the remaining 8.5% there was a 3-4mm variation. The femoral aimer helped in maintaining a thin intact posterior wall with no blow outs. An adequate tunnel length of approximately 35 - 40mm was obtained in all cases.
Conclusion
The study confirmed that femoral offset guide can be a useful tool in placing femoral tunnel in ACL reconstruction. The deviation is minimal from anatomic ACL placement. Hence in the situation of inability to precisely identify the landmarks of anatomic ACL, one can use this as an alternative technique so that a tunnel position without much error can be reproduced even by arthroscopic surgeon in early phase of training.