Evaluating for Tunnel Convergence in Anterior Cruciate Ligament Reconstruction With Modified Lemaire Tenodesis: What Is the Best Tunnel Angle to Decrease Risk?
Por:
Perelli, S, Erquicia, JI, Ibanez, M, Daesino, G, Gelber, PE, Pelfort, X, Monllau, JC
Publicada:
1 mar 2020
Resumen:
Purpose: The purpose of this study was to analyze postoperative computed tomography (CT) scan evaluations of patients who had undergone a combined anterior cruciate ligament (ACL) reconstruction and modified Lemaire anterolateral tenodesis (ALT) with femoral fixation through a bony tunnel. Methods: Postoperative CT scans of 52 patients who had undergone combined ACL and ALT were prospectively evaluated. ACL femoral tunnels were drilled through an anteromedial portal in the center of the native footprint. An ALT fixation tunnel was drilled 5 mm proximal to the lateral epicondyle, aiming at an inclination of 30 degrees proximally and 30 degrees anteriorly. Two independent observers evaluated the CT scans measuring any degree of collision, the shortest distance between the tunnels, and the inclination of the ALT tunnels. Measurements were carried out at both the cortical level and on a plane passing 1 cm deeper in the lateral condyle. Results: At the level of the cortex, no convergence of the tunnels was identified. In 14 of 52 cases (26.9%), the shortest distance between the tunnels was less than 5 mm. Tunnel collision occurred in 8 of 52 cases (15.4%), and the bone bridge between the tunnels was less than 5 mm in 11 cases (21.1%) when the measurements were made on the deeper plane. When the inclination on the axial plane was less than 15 degrees, a collision always (P < .001) occurs. When it was more than 20 degrees, no collision occurred (P < .001). No correlation between convergence and the inclination of the ALT tunnel on the coronal plane was detected. Conclusions: To fix a modified Lemaire ALT through a femoral tunnel avoiding any interference with an anatomic femoral ACL tunnel, we recommend that the femoral tunnel be drilled with an inclination of at least 20 degrees anteriorly.
Filiaciones:
Perelli, S:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Erquicia, JI:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Ibanez, M:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Daesino, G:
Fdn IRCCS Policlin San Matteo, Intervent & Diagnost Radiol & Neuroradiol, Pavia, Italy
Gelber, PE:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Univ Autonoma Barcelona, Hosp Sta Creu & St Pau, Dept Orthopaed Surg, Barcelona, Spain
Pelfort, X:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Hosp Igualada, Consorci Sanitari Anoia, Dept Orthopaed Surg, Barcelona, Spain
Monllau, JC:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport Hosp Univ Dexe, Carrer De Sabino Arana 5, Barcelona 08028, Spain
Univ Autonoma Barcelona, Hosp Mar, Dept Orthopaed Surg, Barcelona, Spain
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