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CORRELATION BETWEEN TUNNEL POSITION ACCORDING TO RADIOLOGICAL DATA AFTER ACL RECONSTRUCTION, SURGEON’S TUNNEL ESTIMATION DURING SURGERY AND ANTROPOMETRIC CHARACTERISTICS OF THE PATIENT
- Authors: Korolev A.V.1, Magnitskaya N.E.1, Ryazantsev M.S.1, Pilipson Z.Y.2, Khashanshin M.M.3, Il’yin D.O.3
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Affiliations:
- ECSTO, European Clinic of Sports Traumatology and Orthopaedics , Peoples Friendship University of Russia
- Moscow State University of Medicine and Stomatology
- ECSTO, European Clinic of Sports Traumatology and Orthopaedics
- Issue: Vol 22, No 1 (2016)
- Pages: 85-95
- Section: Clinical studies
- Submitted: 27.06.2016
- Accepted: 27.06.2016
- Published: 24.06.2016
- URL: https://journal.rniito.org/jour/article/view/27
- DOI: https://doi.org/10.21823/2311-2905-2016-0-1-82-89
- ID: 27
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Abstract
Purpose - to assess the correlation between tunnel position according to radiological data after ACL reconstruction and surgeon’s estimation during surgery. Material and methods. The study included 86 patients who underwent primary ACL reconstruction with the same surgeon and surgical technique in European Clinic of Sports Traumatology and Orthopedics between 2013 and 2015. In all cases hamstring autograft was used and patients received coronal and sagittal radiographs on the first day after surgery. Surgical data on tunnel position were obtained directly from the OR as dictated by the performing surgeon and fixed in the special registry. Radiological data were exported to eFilm, Merge Healthcare software for graphical analysis. Results. The study group included 54 male and 32 female patients, mean age 35.2 ±1,13, range from 17 to 56 years. Analysis of surgical data showed the median femoral tunnel angle on coronal plane to be 45° (IQR 45° - 60°), angle which occurred most often was 45°, median tibial tunnel angle on coronal plane appeared to be 30° (IQR 30° -35°), angle which occurred most often was 30°. According to radiological coronal plane data median femoral tunnel angle accounted 32° (IQR 28° -36°), angle which occurred most often was 35°, while median tibial tunnel angle accounted 20° (IQR 17-25°,) angle which occurred most often was 19°. Coronal plane mean tibial plateau width was 90,2±,1,1mm with tibial tunnel center located on the 48.55% from the medial side. Sagittal plane mean tibial plateau depth was 53,8 ± 0,6 mm with tibial tunnel center located on the 43.95% from the ventral side. Median tibial plateau posterior slope on the sagittal plane accounted 8° (IQR 6°-9°). Conclusion. Tunnel placement during arthroscopic ACL reconstruction could hardly be standardized. Anthropometric differences between patients can lead to different bone tunnel positions even if the procedure is performed by the same surgeon and surgical technique.
About the authors
A. V. Korolev
ECSTO, European Clinic of Sports Traumatology and Orthopaedics , Peoples Friendship University of Russia
Email: fake@neicon.ru
professor of department of traumatology and orthopaedics Россия
N. E. Magnitskaya
ECSTO, European Clinic of Sports Traumatology and Orthopaedics , Peoples Friendship University of Russia
Author for correspondence.
Email: magnitskaya.nina@gmail.com
postgraduate student, department of traumatology, orthopaedics Россия
M. S. Ryazantsev
ECSTO, European Clinic of Sports Traumatology and Orthopaedics , Peoples Friendship University of Russia
Email: fake@neicon.ru
postgraduate student, department of traumatology, orthopaedics and arthrology Россия
Z. Y. Pilipson
Moscow State University of Medicine and Stomatology
Email: fake@neicon.ru
sixth-year student Россия
M. M. Khashanshin
ECSTO, European Clinic of Sports Traumatology and Orthopaedics
Email: fake@neicon.ru
orthopaedics trauma surgeon Россия
D. O. Il’yin
ECSTO, European Clinic of Sports Traumatology and Orthopaedics
Email: fake@neicon.ru
orthopaedics trauma surgeon Россия
References
- Аксёнов С.Ю. Анализ отдаленных результатов пластики передней крестообразной связки аутотрансплантатами из сухожилий подколенных сгибателей и связки. [Автореф. дис. … канд. мед. наук]. М.; 2015. 24 с.
- Головаха М.Л., Шишка И.В., Банит О.В., Красноперов С.Н., Шабус Р., Орлянский В. Влияние сагиттального наклона тибиального плато на риск повреждения передней крестообразной связки. Вісник ортопедії травматології та протезування. 2011; (2):34-37.
- Заремук А.М., Лисицын М.П., Ткаченко Е.А., Бухарь С.В., Горевич И.И. Ревизионная хирургия передней крестообразной связки: несостоятельность и повторный разрыв аутотрансплантата. Эндоскопическая хирургия. 2011; 17(6): .34-37.
- Карасева Т.Ю., Карасев Е.А. Артроскопические технологии лечения больных с нестабильностью коленного сустава. Гений ортопедии. 2013; (4): .38-43.
- Королев А.В., Загородний Н.В., Гнелица Н.Н., Дедов С.Ю., Федорук Г.В., Ахпашев А.А. Артроскопическая реконструкция передней крестообразной связки аутотран- сплантатом из связки надколенника: методические рекомендации. М.: Наука; 2004. 63 с.
- Лазишвили Г.Д. Оперативное лечение повреждений связочно-капсульного аппарата коленного сустава [Автореф. дис. … канд. мед. наук]. М.; 2005. 22 с.
- Лисицын М.П. Артроскопическая реконструкция повреждений передней крестообразной связки коленного сустава с использованием компьютерной навигации и перспективы ее морфо-функционального восстановления [Автореф. дис. … д-ра мед. наук]. М.; 2012. 48 с.
- Миронов С.П., Лисицын М.П. Ошибки в расположении трансплантата при артроскопической реконструкции передней крестообразной связки коленного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2011; (1):89-94.
- Серебряк Т.В. Артроскопическая реконструкция передней крестообразной связки с использованием различных сухожильных трансплантатов [Автореф. дис. …канд. мед. наук]. СПб.; 2012. 23 с.
- Фоменко С.М. Артроскопическое лечение сочетанных разрывов передней крестообразной связки (ПКС) коленного сустава (КС) [Автореф. дис. … канд. мед. наук]. Новосибирск; 2005. 138 с.
- Christensen J.J., Krych A.J., Engasser W.M., Vanhees M.K., Collins M.S., Dahm D.L. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med. 2015; 43(10):2510-2514.
- Giron F., Losco M., Giannini L., Buzzi R. Femoral tunnel in revision anterior cruciate ligament reconstruction. Joints. 2013; 1(3):126.
- Howell S.M., Gittins M.E., Gottlieb J.E., Traina S.M., Zoellner T.M. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med. 2001; 29(5):567-574.
- Jameson S.S., Dowen D., James P., Serrano-Pedraza I., Reed M.R., Deehan D. Complications following anterior cruciate ligament reconstruction in the English NHS. Knee. 2012; 19(1):14-19.
- Jepsen C.F., Lundberg-Jensen A.K., Faunoe P. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligamentreconstructed knee? A clinical, prospective, randomized, double-blind study. Arthrosc J Arthrosc Relat Surg. 2007; 23(12):1326-1333.
- Jonsson H., Elmqvist L.-G., Karrholm J., Tegner Y. Overthetop or tunnel reconstruction of the anterior cruciate ligament? A prospective randomised study of 54 patients. J Bone Joint Surg Br. 1994; 76(1):82-87.
- Lee M.C., Seong S.C., Lee S., Chang C.B., Park .YK., Jo H., et al. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg. 2007; 23(7):771-778.
- Loh J.C., Fukuda Y., Tsuda E., Steadman R.J., Fu F.H., Woo S.L. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthrosc J Arthrosc Relat Surg. 2003; 19(3):297-304.
- Lyman S., Koulouvaris P., Sherman S., Do H., Mandl L.A., Marx R.G. Epidemiology of anterior cruciate ligament reconstruction. J Bone Joint Surg. 2009; 91(10): 2321-2328.
- Pascual-Garrido C., Swanson B.L., Swanson K.E. Transtibial versus low anteromedial portal drilling for anterior cruciate ligament reconstruction: a radiographic study of femoral tunnel position. Knee Surg Sports Traumatol Arthrosc. 2013; 21(4):846-850.
- Ramme A.J., Wright R.W., Brophy R.H., McCarty E.C., Vidal A.R., Parker R.D. et al. Variability in ACL tunnel placement observational clinical study of surgeon ACL tunnel variability. Am J Sports Med. 2013; 41(6):1265-1273.
- Romano V.M., Graf B.K., Keene J.S., Lange R.H. Anterior cruciate ligament reconstruction The effect of tibial tunnel placement on range of motion. Am J Sports Med. 1993; 21(3):415-418.
- Scopp J.M., Jasper L.E., Belkoff S.M., Moorman C.T. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthrosc J Arthrosc Relat Surg. 2004; 20(3):294-299.
- Simmons R., Howell S.M., Hull M.L. Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg. 2003; 5(6):1018-1029.
- Sommer C., Friederich N.F., Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc. 2000; 8(4):207-213.
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