BEST KNEE FLEXION ANGLE THROUGH ANTEROMEDIAL PORTAL DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGHui ¹ , WANGJinshui ¹ , HANXuesong ² ,  WANGWanming ²

1. Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou Fujian, 350025, P. R. China;
2. No.2 Department of Orthopedics, Fuzhou General Hospital of Nanjing Command;

Corresponding author：

WANGWanming, Email: wangwm93@126.com

Keywords：

Anterior cruciate ligament reconstruction; Anteromedial portal; Femoral tunnel; Knee flexion angle

DOI：

10.7507/1002-1892.20140128

Video：

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Objective To investigate the best knee flexion angle by analyzing the length and orientation of the femoral tunnel through anteromedial portal (AM) at different flexion angles during anterior cruciate ligament (ACL) reconstruction. Methods Twelve fresh cadaveric knees were selected to locate the center of ACL femoral footprint through AM using the improved hook slot vernier caliper, and to locate the posterior bone cortex using a diameter 3 mm ball at flexion of 90, 100, 110, 120, and 130°. The femoral tunnel length, standard coronal and sagittal plane angles, and the position relation between exit point and the lateral epicondyle were measured; the tunnel orientation on the anteroposterior and lateral X-ray films was also measured. Results With increasing flexion of the knee, the femoral tunnel length showed a first increasing and then stable tendency; significant difference was found between at flexion of 90°and at flexions of 100, 110, 120, and 130°, and between flexions of 100°and 120°(P<0.05). The femoral tunnel showed a trend of decreasing with coronal angle, whereas gradually increasing with sagittal angle. The knee flexion angle had significant difference either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). The exit point of the femoral tunnel located at the lateral epicondyle of the femur proximal to posterior region at flexion of 90°in all knees, and at flexion of 100°in 7 knees, but it located at the lateral epicondyle of the femur proximal to anterior region at flexion of 110, 120, and 130°in all knees. As the knee flexion angle increasing, the angle between femoral tunnel with the tangent of internal-external femoral condyle on anteroposterior X-ray films showed a trend of decreasing gradually, but a trend of increasing gradually on lateral X-ray films. On the anteroposterior X-ray films, significant differences were found in the angle either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). On the lateral X-ray films, there were significant differences in the angle among flexions of 90, 100, 110, 120, and 130°(P<0.05). Conclusion During ACL reconstruction by AM, 110°is the best flexion angle, which can get the ideal femoral tunnel.

Citation： WANGHui, WANGJinshui, HANXuesong, WANGWanming. BEST KNEE FLEXION ANGLE THROUGH ANTEROMEDIAL PORTAL DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 571-575. doi: 10.7507/1002-1892.20140128 Copy

1.	Fu FH, Shen W, Starman JS, et al. Primary anatomic double-bundle anterior cruciate ligament reconstruction:a preliminary 2-year prospective study. Am J Sports Med, 2008, 36(7):1263-1274.
2.	Nakamae A, Ochi M, Adachi N, et al. Far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction:a cadaveric study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1):181-187.
3.	Fu FH, Karlsson J. A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9):1151-1153.
4.	Basdekis G, Abisafi C, Christel P. Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Arthroscopy, 2008, 24(4):459-464.
5.	Chang MJ, Chang CB, Won HH, et al. Anteromedial portal versus outside-in technique for creating femoral tunnels in anatomic anterior cruciate ligament reconstructions. Arthroscopy, 2013, 29(9):1533-1539.
6.	Cha PS, Brucker PU, West RV, et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction:an anatomic approach. Arthroscopy, 2005, 21(10):1275.
7.	Dave LY, Nyland J, Caborn DN. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout:a cadaveric study. Arthroscopy, 2012, 28(10):1381-1387.
8.	Otani M, Nozaki M, Kobayashi M, et al. Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5):838-843.
9.	向先祥, 赵德伟, 王卫明, 等. 胫骨-股骨单隧道双束解剖重建前交叉韧带. 中华关节外科杂志(电子版), 2013, 7(1):30-34.
10.	Osaki K, Okazaki K, Tashiro Y, et al. Influences of knee flexion angle and portal position on the location of femoral tunnel outlet in anterior cruciate ligament reconstruction with anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
11.	Segawa H, Koga Y, Omori G, et al. Influence of the femoral tunnel location and angle on the contact pressure in the femoral tunnel in anterior cruciate ligament reconstruction. Am J Sports Med, 2003, 31(3):444-448.
12.	沈光思, 徐又佳, 周海斌, 等. 前交叉韧带重建术股骨隧道角度与隧道壁承受应力关系的研究. 临床骨科杂志, 2008, 11(5):469-472.
13.	Farrow LD, Parker RD. The relationship of lateral anatomic structures to exiting guide pins during femoral tunnel preparation utilizing an accessory medial portal. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6):747-753.
14.	LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee:a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6):854-860.
15.	曾蜀雄, 伍国胜, 董喜乐, 等. 膝关节腓侧副韧带的解剖学观察及其临床意义. 解剖学报, 2011, 42(4):513-516.
16.	林宇进, 覃健, 黄保华, 等. 腓肠肌起点解剖观察及其在全膝关节置换术中的意义. 解剖学杂志, 2012, 35(2):213-216.

1. Fu FH, Shen W, Starman JS, et al. Primary anatomic double-bundle anterior cruciate ligament reconstruction:a preliminary 2-year prospective study. Am J Sports Med, 2008, 36(7):1263-1274.
2. Nakamae A, Ochi M, Adachi N, et al. Far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction:a cadaveric study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1):181-187.
3. Fu FH, Karlsson J. A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9):1151-1153.
4. Basdekis G, Abisafi C, Christel P. Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Arthroscopy, 2008, 24(4):459-464.
5. Chang MJ, Chang CB, Won HH, et al. Anteromedial portal versus outside-in technique for creating femoral tunnels in anatomic anterior cruciate ligament reconstructions. Arthroscopy, 2013, 29(9):1533-1539.
6. Cha PS, Brucker PU, West RV, et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction:an anatomic approach. Arthroscopy, 2005, 21(10):1275.
7. Dave LY, Nyland J, Caborn DN. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout:a cadaveric study. Arthroscopy, 2012, 28(10):1381-1387.
8. Otani M, Nozaki M, Kobayashi M, et al. Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5):838-843.
9. 向先祥, 赵德伟, 王卫明, 等. 胫骨-股骨单隧道双束解剖重建前交叉韧带. 中华关节外科杂志(电子版), 2013, 7(1):30-34.
10. Osaki K, Okazaki K, Tashiro Y, et al. Influences of knee flexion angle and portal position on the location of femoral tunnel outlet in anterior cruciate ligament reconstruction with anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
11. Segawa H, Koga Y, Omori G, et al. Influence of the femoral tunnel location and angle on the contact pressure in the femoral tunnel in anterior cruciate ligament reconstruction. Am J Sports Med, 2003, 31(3):444-448.
12. 沈光思, 徐又佳, 周海斌, 等. 前交叉韧带重建术股骨隧道角度与隧道壁承受应力关系的研究. 临床骨科杂志, 2008, 11(5):469-472.
13. Farrow LD, Parker RD. The relationship of lateral anatomic structures to exiting guide pins during femoral tunnel preparation utilizing an accessory medial portal. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6):747-753.
14. LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee:a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6):854-860.
15. 曾蜀雄, 伍国胜, 董喜乐, 等. 膝关节腓侧副韧带的解剖学观察及其临床意义. 解剖学报, 2011, 42(4):513-516.
16. 林宇进, 覃健, 黄保华, 等. 腓肠肌起点解剖观察及其在全膝关节置换术中的意义. 解剖学杂志, 2012, 35(2):213-216.

Chinese Journal of Reparative and Reconstructive Surgery

BEST KNEE FLEXION ANGLE THROUGH ANTEROMEDIAL PORTAL DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

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