App-Based Analysis of Fluoroscopic Images According to Bernard-Hertel Method for the Determination of Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction
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PROVIDER: S-EPMC10907940 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Revision anterior cruciate ligament (ACL) reconstruction is accompanied by several technical challenges that must be addressed, such as a primary malpositioned bone tunnel, pre-existing hardware, or bone defects due to tunnel expansion. We describe a surgical technique used to create an anatomic femoral socket using a 3-dimensional (3D) fluoroscopy-based navigation system in technically demanding revision cases. After a reference frame is rigidly attached to the femur, an intraoperative image of the distal femur is obtained, which is transferred to a navigation system and reconstructed into a 3D image. A navigation computer helps the surgeon to visualize the whole image of the lateral wall of the femoral notch, even if the natural morphology of the intercondylar notch has been destroyed by the primary procedure. In addition, the surgeon can also confirm the position of the previous bone tunnel aperture, the previous exit of the femoral tunnel, and the presence of any pre-existing hardware on the navigation monitor. When a new femoral guidewire for the revision procedure is placed, the virtual femoral tunnel is overlaid on the reconstructed 3D image in real time. At our institution, 12 patients underwent 1-stage revision ACL procedures with the assistance of this computer navigation system, and the grafts were securely fixed in anatomically created tunnels in all cases. This technology can assist surgeons in creating anatomic femoral tunnels in technically challenging revision ACL reconstructions.
| S-EPMC3678652 | biostudies-literature
Project description:BackgroundFemoral tunnel can be drilled through tibial tunnel (TT), or independent of it (TI) by out-in (OI) technique or by anteromedial (AM) technique. No consensus has been reached on which technique achieves more proper femoral aperture position because there have been evolving concepts in the ideal place for femoral aperture placement. This meta-analysis was performed to analyze the current literature comparing femoral aperture placement by TI versus TT techniques in ACL reconstruction.MethodsWe performed a comprehensive systematic review and meta-analysis of English-language literature in PubMed, Cochrane, and Web of Science databases for articles comparing femoral aperture placement by TI versus TT techniques with aperture position assessed by direct measurement or by postoperative imaging, PXR and/or CT and/or MRI.ResultsWe included 55 articles with study population of 2401 knees of whom 1252 underwent TI and 1149 underwent TT techniques. The relevant baseline characteristics, whenever compared, were comparable between both groups. There was nonsignificant difference between TI and TT techniques in the distance from aperture center to footprint center and both techniques were unable to accurately recreate the anatomic footprint position. TI technique significantly placed aperture at more posterior position than TT technique. TI technique significantly lowered position of placed aperture perpendicular to Blumensaat's line (BL) than TT technique, and modifications to TT technique had significant effect on this intervention effect. Regarding sagittal plane aperture placement along both AP anatomical axis and BL, there was nonsignificant difference between both techniques.ConclusionModifications to TT technique could overcome limitations in aperture placement perpendicular to BL. The more anterior placement of femoral aperture by TT technique might be considered, to some extent, a proper position according to recent concept of functional anatomical ACL reconstruction.
| S-EPMC8931956 | biostudies-literature
Project description:Arthroscopic reconstruction of the anterior cruciate ligament (ACL) remains one of the most commonly performed procedures in orthopaedic surgery. We describe a technique to visualize the button being advanced through the femoral tunnel using an arthroscope placed in the anteromedial portal. Looking into the femoral tunnel in line with the sutures, this technique allows the surgeon to directly visualize the femoral button as it traverses the femoral tunnel and confirms that it is engaged over the femoral cortex. Certain complications can arise, however, with the use of a suspensory fixation with a button on the femoral cortex. This method can decrease operative time and complication rates.
| S-EPMC5495202 | biostudies-literature
Project description:Bone tunnel creation in the anatomical location is essential in anterior cruciate ligament (ACL) reconstruction with an autogenous graft and is commonly performed with a drill bit matched to graft diameter. Anatomic rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone autograft has been developed to anatomically create bone tunnels inside the ACL footprints and has been reported to achieve excellent outcomes. To make the rectangular tunnel, the surgeon needs to dilate 2 adjacent bone tunnels after creation of 2 round tunnels with a drill bit, while the tunnel wall occasionally cracks during dilating. An ultrasonic (US) device was developed with improvement of output power and has been implemented with a rectangular shape blade in the field of arthroscopic surgery. This US device can provide a precise and effective bone cut compared to drills. We introduced this device to clinically create a rectangular tunnel during ACL reconstruction. The US device can be useful for rectangular femoral tunnel creation and can create a precise rectangular femoral tunnel in the ACL footprint.
| S-EPMC10466142 | biostudies-literature
Project description:During reconstruction surgery of the anterior cruciate ligament, the evolution of the femoral tunnel from the transtibial to the transportal path provides greater accuracy in reaching the desired anatomic point. However, there are also some new challenges, such as correct execution, reproducibility, and minimizing the risk of iatrogenic injury from its use. In an effort to overcome these challenges, we have proposed the use of a positioner, which was developed by our group and allows the leg to stay in the desired position, without variations in the operation or aid from a medical assistant. This manuscript presents our femoral tunnel preparation technique and its application in clinical practice.
| S-EPMC6993486 | biostudies-literature
Project description:PurposeThe purpose of this study was to evaluate the positions of femoral bone sockets and tibial bone tunnels made with the rectangular retro-dilator (RRD), which we manufactured for anterior cruciate ligament reconstruction (ACLR) with a bone-patella tendon-bone (BPTB) graft which is fixed into the rectangular bone socket and tunnel made at anatomical ACL insertion sites.Methods42 patients who had undergone ACLR with BPTB using the RRD were evaluated to assess bone socket and tunnel positions by the quadrant method and Magnussen classification using three-dimensional (3-D) CT. Intra-operative complications were also investigated in all patients.Results3-D CT of the operated knee joints using the RRD showed that the bone socket and tunnel were placed in anatomical positions. In the quadrant method, the mean position of the femoral bone socket aperture was located at 22.0 ± 4.2% along the Blumensaat's line, and 37.4 ± 7.2% across the posterior condylar rim. The mean positions of the tibial bone tunnel aperture were 37.7 ± 5.2% and 46.1 ± 2.2% antero-posteriorly and medio-laterally, respectively. In addition, according to the Magnussen classification, 39 cases were evaluated as type 1, and almost all were located behind the lateral intercondylar ridge (also known as the resident's ridge). 3 cases were classified as type 2, which overlapped with the resident's ridge. A partial fracture of BPTB bone fragment was observed in 2 patients, but no serious complications including neurovascular injury were observed.ConclusionThe study indicates that the use of RRD achieves a safe anatomical reconstruction of the ACL.
| S-EPMC6497238 | biostudies-literature
Project description:Recent literature has led some surgeons to drill the femoral tunnel in an anterior cruciate ligament reconstruction through an accessory anteromedial portal. Several techniques have been reported for the safe, effective drilling of the femoral tunnel by this approach. This technical note presents a new "retrograde technique" in which all instruments are passed independently into the notch and across the medial compartment. This technique is safe and reproducible and allows for meticulous evaluation and creation of the femoral tunnel(s) while minimizing steps.
| S-EPMC3882676 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and progressive instability and disability may develop in a significant number of patients. The incidence of ACL reconstruction is rapidly increasing, as is the number of failures. Although ACL reconstruction is a common procedure, less than satisfactory outcomes have been reported to occur in up to 25% of patients. The reasons for clinical failure after ACL reconstruction are numerous but can be broadly separated into 3 categories: technical, biological, and mechanical failures. It is generally thought that poor tunnel positioning (especially the femoral tunnel) is the most common technical error. Revision ACL reconstruction can be performed in 1 or 2 stages. The decision to perform a multistage approach is based on the position and size of the original tunnels. The varied success rates and associated advantages and disadvantages of each method have resulted in controversy as to the best treatment for revision ACL surgery. We describe our preferred operative technique to remove a fractured nitinol synthetic ACL graft and manage single-stage revision ACL reconstruction without bone grafting.
| S-EPMC5443615 | biostudies-literature
Project description:Because various biomechanical studies and clinical results have shown the effectiveness of an anatomical approach for anterior cruciate ligament (ACL) reconstruction, this approach has become gradually commonplace to improve postoperative performance. Standard tunnel positioning methods with accuracy, reproducibility, and adaptability to varied concepts are essential for the success of anatomical ACL reconstruction. However, there were no standard tibial tunnel positioning methods to satisfy these conditions. This technical note reports our tibial tunnel positioning technique using bony and/or anatomical landmarks for anatomical ACL reconstruction.
| S-EPMC5368106 | biostudies-literature
Project description:A technique for associated anterior cruciate ligament and fibular collateral ligament reconstruction is shown, using a single hamstring tendon graft, which is prepared asymmetrically, leaving one-third of the length with a single diameter and two-thirds with a double diameter. A single femoral tunnel is created, using an interference screw for fixation and isolation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length. The objective of this Technical Note is to provide the orthopaedic surgeon with a resource for anterior cruciate ligament and fibular collateral ligament reconstruction even with short grafts, saving bone stock and avoiding the need for allografts.
| S-EPMC6112055 | biostudies-literature