Yonsei Med J.  2014 Nov;55(6):1592-1599. 10.3349/ymj.2014.55.6.1592.

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

• Lee SH
• Choi JY
• Kim DH
• Kang BJ
• Nam DC
• Yoon HK
• Hwang SC

• KMID: 2070207
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1592

Abstract

PURPOSE
The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees.
MATERIALS AND METHODS
The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured.
RESULTS
In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel.
CONCLUSION
The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.

Keyword

Anterior cruciate ligament; femoral tunnel; double bundle reconstruction

MeSH Terms

Aged
Anterior Cruciate Ligament/*anatomy & histology/surgery
Anterior Cruciate Ligament Reconstruction/*methods
*Bone Wires
Cadaver
Female
Femur/*anatomy & histology/surgery
Humans
Knee Joint/surgery
Male
Middle Aged
Tibia/*anatomy & histology/surgery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Guide wires were inserted through the center of the femoral anteromedial and posterolateral footprint of the anterior cruciate ligament at angle of 45° in the axial plane on knees flexed at 110°. Two guide wires were inserted in cadaveric femur: (A) Anteroposterior view. (B) Lateral view.

• 

  Fig. 2 The virtual anteromedial and posterolateral tunnel cylinders were created at the femoral side using Geomagic Software (Research Triangle Park, NC, USA) and bone bridge thickness were measured. (A) Anteroposterior view. (B) Lateral view.

• 

  Fig. 3 Tunnel communication caused by drilling was observed. (A) At the level of the enterance by gross specimen. (B) Along the whole tunnel using a 3 dimensional virtual cylinder model.

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