Background: Tunnels created for reconstruction of a torn anterior cruciate ligament (ACL) are critical determinants of joint stability and clinical outcomes. There is limited objective evidence on the ability of transtibial (TT), anteromedial (AM) portal, and outside-in (OI) operative techniques in creating anatomic tunnels.
Hypothesis: (1) Tibial tunnel-independent techniques can create tunnels more accurately at the anatomic ACL footprint center than the TT technique, and (2) femoral tunnel exit location of the OI and TT techniques on the lateral cortex will be significantly further away from the lateral epicondyle than the femoral tunnel exit location of the AM portal technique.
Study Design: Controlled laboratory study.
Methods: Eight cadaveric knee specimens with a mean age of 56 years were used in this study. A digitizing system was used to record points along the outlines of the ACL insertion area and apertures of tunnels created by the TT, AM portal, and OI techniques. The following parameters were measured from the digitized points: (1) amount of ACL, anteromedial bundle, and posterolateral bundle coverage by the tunnels; (2) relationship between the centers of the ACL and the tunnels; and (3) distance between the center of the femoral tunnel exit and the lateral epicondyle. All the recorded parameters were analyzed in 3-dimensional solid modeling software.
Results: The percentage of ACL footprint coverage achieved by all 3 surgical techniques was not significantly different from one another. However, larger femoral posterolateral bundle coverage was observed in tunnels created by the AM portal and OI techniques than in the TT tunnel. In terms of anteromedial bundle coverage, no significant differences were observed between the 3 techniques. On average, 27.1% ± 17.4% of the TT tunnel was outside the ACL footprint. This was significantly larger compared with 13.6% ± 15.7% with the AM portal technique (P = .01) and 10.8% ± 10.8% in the OI technique (P = .01). Centers of femoral tunnels created by the TT, AM portal, and OI techniques were located at a distance of 3.0 ± 1.5 mm, 2.1 ± 0.9 mm, and 1.5 ± 1.2 mm, respectively, from the ACL footprint center. The femoral tunnel exit location of the AM portal technique on the lateral femoral cortex was closer to the lateral epicondyle than the femoral tunnel exit location of the OI and TT techniques.
Conclusion: Findings of this study indicate that a larger posterolateral bundle coverage is achieved by the AM portal and OI techniques than by the TT technique. Centers of the tunnels created by the AM portal and OI techniques were closer to the native ACL footprint center than the center of the TT technique tunnel. The incidence of a posterior femoral tunnel exit relative to the lateral epicondyle is higher in the AM portal technique than in the OI and TT techniques.
Clinical Relevance: For ACL reconstruction using soft tissue grafts, tibial tunnel-independent techniques can produce more anatomic tunnels than the TT technique.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740359 | PMC |
http://dx.doi.org/10.1177/0363546511434276 | DOI Listing |
ACS Nano
January 2025
Department of Physics, University of Basel, Klingelbergstrasse 82, Basel 4056, Switzerland.
Flat bands in Kagome graphene might host strong electron correlations and frustrated magnetism upon electronic doping. However, the porous nature of Kagome graphene opens a semiconducting gap due to quantum confinement, preventing its fine-tuning by electrostatic gates. Here we induce zero-energy states into a semiconducting Kagome graphene by inserting π-radicals at selected locations.
View Article and Find Full Text PDFJBJS Essent Surg Tech
January 2025
The Ohio State University College of Medicine, Columbus, Ohio.
Background: An all-inside endoscopic flexor hallucis longus (FHL) tendon transfer is indicated for the treatment of chronic, full-thickness Achilles tendon defects. The aim of this procedure is to restore function of the gastrocnemius-soleus complex while avoiding the wound complications associated with open procedures.
Description: This procedure can be performed through 2 endoscopic portals, a posteromedial portal (the working portal) and a posterolateral portal (the visualization portal).
The integrity and phenotype of periodontal soft tissues significantly influence the outcome of surgical periodontal regenerative therapy. In cases with thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and thin phenotype.
View Article and Find Full Text PDFNat Commun
January 2025
CNR Nanotec, Institute of Nanotechnology, via Monteroni, 73100, Lecce, Italy.
Macroscopic coherence in quantum fluids allows the observation of interference effects in their wavefunctions, and enables applications such as superconducting quantum interference devices based on Josephson tunneling. The Josephson effect manifests in both fermionic and bosonic systems, and has been well studied in superfluid helium and atomic Bose-Einstein condensates. In exciton-polariton condensates-that offer a path to integrated semiconductor platforms-creating weak links in ring geometries has so far remained challenging.
View Article and Find Full Text PDFPurpose: To clarify the femoral tunnel location for a virtual anterior cruciate ligament (ACL) graft to simulate the native ACL.
Methods: Three-dimensional (3D) computed tomography (CT) and magnetic resonance imaging (MRI) were obtained in 14 normal knees in full extension. Two types of virtual triple bundle ACL grafts (VACLG) were created.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!