Yonsei Med J.  2014 Nov;55(6):1584-1591. 10.3349/ymj.2014.55.6.1584.

Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation

• Moon DK
• Yoon CH
• Park JS
• Kang BJ
• Cho SH
• Jo HS
• Hwang SC

• KMID: 2070206
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1584

Abstract

PURPOSE
The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation.
MATERIALS AND METHODS
Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured.
RESULTS
In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001).
CONCLUSION
Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.

Keyword

Anterior cruciate ligament; femoral tunnel; medial femoral condyle; computer simulation; anteromedial portal

MeSH Terms

Aged
Anterior Cruciate Ligament/*surgery
Anterior Cruciate Ligament Reconstruction/instrumentation/*methods
Cadaver
Computer Simulation
Female
Femur/anatomy & histology/*surgery
Humans
Imaging, Three-Dimensional
Knee Joint/radiography/*surgery
Male
Middle Aged
Osteotomy/*methods
Outcome and Process Assessment (Health Care)
Patient Positioning
Surgical Instruments
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The ACL insertion is outlined on the femur. ACL, anterior cruciate ligament.

• 

  Fig. 2 Three-dimensional measurements were calculated using Geomagic, Inc. software.

• 

  Fig. 3 The femoral tunnel aperture center was measured in posterior-to-anterior and proximal-to-distal directions using the quadrant method. H, line perpendicular to Blumensaat line; T, line parallel to Blumensaat line.

• 

  Fig. 4 Excluded angles by computer simulation above 60° in axial plane and below 30° in coronal plane are shown.

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  Fig. 5 The femoral tunnel length is shown in (A) and the distance between the imaginary extension of the femoral tunnel and medial femoral condyle (B) was measured at standard entry angle.

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