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Short-Term Outcomes of All-Inside Anterior Cruciate Ligament Reconstruction by the Trans-Femoral Approach

Short-Term Outcomes of All-Inside Anterior Cruciate Ligament Reconstruction by the Trans-Femoral Approach

Toshiaki Takahashi, MD, PhD, Prof., JAPAN Seiji Watanabe, MD, JAPAN

Ehime University, Department of Sports and Health Science, Matsuyama , Ehime, JAPAN


2023 Congress   ePoster Presentation   2023 Congress   Not yet rated

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Patient Populations

Diagnosis Method

Sports Medicine


Summary: We created a drill guide for the trans-femoral approach and improved an all-inside anterior cruciate ligament (ACL) reconstruction technique. We reported outcomes at least 2 years after surgery using this technique in 35 joints. This method is considered to make femoral tunnel drilling relatively easy, and to reduce the incidence of tibial damage.


Purpose

We created a drill guide for the trans-femoral approach and improved an all-inside anterior cruciate ligament (ACL) reconstruction technique that uses the drill guide to drill tibial and femoral tunnels after determining the femoral drilling position. We reported outcomes at least 2 years after surgery using this technique.

Methods

A total of 35 knees of 35 patients were followed-up at least 2 years after one-route ACL reconstruction procedures using the all-inside trans-femoral approach. The mean patient age was 36 years and the mean postoperative follow-up period was 28.9 months (range: 24–48 months).
Our created femoral drill guide was placed at the center of the ACL femoral footprint. A hole-in-one guide was then placed to locate the anterior tibial tunnel outlet of the tibial route. Next, the femoral and tibial tunnels were drilled. A drill pin-reamer assembly dedicated for this technique was then inserted into the knee joint and the femoral and tibial tunnels were made. The diameter of the fixation suture hole in the tibial route is 2.4 mm.
The centers of the femoral and tibial tunnels were measured by three-dimensional computed tomography (3D-CT) within a week after surgery. The center of the femoral tunnel was measured using the quadrant method, and that of the tibial tunnel was assessed using Stäubli’s technique.

Results

The mean side-to-side difference in KT-1000 measurements improved from 4.4±1.1 mm preoperatively to 0.30±0.8 mm postoperatively. The mean Lysholm score improved from 62.1±12.7 preoperatively to 96.6±4.5 postoperatively. The semitendinosus tendon was used as a graft material in 34 patients. The mean length and diameter of the obtained graft were 55.1±0.8 mm and 8.7±0.5 mm, respectively. The mean length of the intra-articular part of the graft was 25.6±2.2 mm and the mean length of the femoral route was 39.6±4.5 mm. The mean length of the tibial tunnels was 19.7±2.1 mm. The position of the femoral tunnel measured by 3D-CT was a mean of 34.8±6.1% of the distance from the posterior femoral condyle and a mean of 35.6±8.6% of the height from Blumensaat's line. The position of the tibial tunnel measured by 3D-CT was a mean of 48.1±3.6% of the distance from the medial edge of the tibia and a mean of 39.8±7.2% of the distance from the anterior edge of the tibia.
Comparison of the tibial tunnel positions between the knees with internal rotation of the lower limb (n=22) and those without (n=13) showed no difference in the Lysholm score or the KT-1000 measurement, and the tibial tunnel positions in the knees with internal rotation were closer to the center and were more favorable.

Conclusion

This is the first report on a bone drilling method using a single drill guide in an all-inside ACL reconstruction procedure with the trans-femoral approach. This method is considered to make femoral tunnel drilling relatively easy, and to reduce the incidence of tibial damage. The tibial tunnel position was more favorable in the knees with internal rotation of the lower limb than those without.


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