Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction

Peres, Luciano Rodrigo; Teixeira, Matheus Silva; Scalizi Júnior, Caetano; Akl Filho, Wolf

doi:10.1016/j.rboe.2018.05.001

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Revista Brasileira de Ortopedia

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Sumário

Artigos Originais • Rev. bras. ortop. 53 (4) • Jul-Aug 2018 • https://doi.org/10.1016/j.rboe.2018.05.001 copy

Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction^☆ ☆ Study conducted at Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the inclination and the length of the femoral tunnel in patients submitted to anterior cruciate ligament reconstruction (ACL) surgery by transtibial and anatomical techniques.

Methods:

This is an analytical observational study in patients with ACL injury that underwent arthroscopic reconstruction through transtibial and anatomical surgical techniques. In the immediate postoperative period, computed tomography (CT) and anteroposterior (AP) view digital radiographs (X-rays) were performed to evaluate the inclination and length of the femoral tunnel.

Results:

Forty-two patients were analyzed: 27 underwent anatomical reconstruction and 15, transtibial reconstruction. The inclination angle and tunnel length by the transtibial technique are always greater than by the anatomical technique. The mean inclination angles were 59.75º (53.9-66.1º) in the X-rays and 54.17º (43.5-62.3º) in CT for the transtibial technique, and 42.91º (29.3-57.4º) in the X-rays and 39.10º (23.8-50.6º) in CT for the anatomical technique. Regarding the length of the femoral tunnel, the transtibial technique promotes longer tunnels: mean 55.7 mm (40.0-70.2 mm) in the transtibial and 35.5 mm (24.5-47 mm) in the anatomical technique. No statistically significant correlation was observed between the length and the inclination of the tunnel, regardless of the technique used. Thus, these variables can be considered as independent.

Conclusion:

The anatomical reconstruction technique presented shorter femoral tunnels and lower angle of inclination than the transtibial technique. The CT showed smaller inclination angle than the X-rays, regardless of the surgical technique.

Keywords:
Knee joint; Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Radiography; Computed tomography by X-rays

Gender	Anatomical		Transtibial		p
	n	%	n	%
Female	6	22.2	5	33.3	0.433
Male	21	77.8	10	66.7

	Mean	Median	Min	Max	n	p
Anatomical
X-ray	42.91	44.0	29.3	57.4	27	<0.001
CT	39.10	40.6	23.8	50.6	27

Transtibial
X-ray	59.75	59.4	53.9	66.1	15	<0.001
CT	54.17	56.2	43.5	62.3	15

All
X-ray	48.93	50.1	29.3	66.1	42	<0.001
CT	44.48	43.5	23.8	62.3	42

	Correlation (r)	p-Value
Anatomical	0.172	0.390
Transtibial	0.191	0.495

Surgical technique	Mean	Median	Standard deviation	CV (%)	Min	Max	n	p
Age
Anatomical	35.2	37	10.2	29	15	49	27	0.192
Transtibial	30.7	29	11.2	37	16	55	15

X-ray angle
Anatomical	42.91	44.0	7.94	19	29.3	57.4	27	<0.001
Transtibial	59.75	59.4	4.16	7	53.9	66.1	15

CT angle
Anatomical	39.10	40.6	7.16	18	23.8	50.6	27	<0.001
Transtibial	54.17	56.2	5.94	11	43.5	62.3	15

Tunnel length
Anatomical	35.50	35.5	5.74	16	24.5	47.0	27	<0.001
Transtibial	55.76	54.2	9.50	17	40.0	70.2	15

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Conflicts of interest

The authors declare no conflicts of interest.

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Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction☆ ☆ Study conducted at Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Radiological evaluation of the femoral tunnel positioning in anterior cruciate ligament reconstruction^☆ ☆ Study conducted at Grupo do Joelho, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.