Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique.

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_3D14434D5997
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique.
Périodique
Journal of Orthopaedic Surgery and Research
Auteur(s)
Garofalo R., Moretti B., Kombot C., Moretti L., Mouhsine E.
ISSN
1749-799X (Electronic)
ISSN-L
1749-799X
Statut éditorial
Publié
Date de publication
2007
Volume
2
Pages
10
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Endoscopic anterior cruciate ligament (ACL) reconstruction can be performed through one-incision or two-incision technique. The current one-incision endoscopic ACL single bundle reconstruction techniques attempt to perform an isometric repair placing the graft along the roof of the intercondylar notch, anterior and superior to the native ACL insertion. However the ACL isometry is a theoretical condition, and has not stood up to detailed testing and investigation. Moreover this type of reconstruction results in a vertically oriented non-anatomic graft, which is able to control anterior tibial translation but not the rotational component of the instability. Femoral tunnel obliquity has a great effect on rotational stability. To improve the obliquity of graft, an anatomical ACL reconstruction should be attempt. Anatomical insertion of ACL on the femur lies very low in the notch, spreading between 11 and 9-8 o'clock position and the center lies lower than at 11 o'clock position. Femoral aiming devices through the tibial tunnel aim at an isometric placement, and they do not aim at an anatomic position of the graft. Also, a placement of tunnel in a position of 11 o'clock is unable to restore rotational stability. The two-incision technique, with the possibility to position femoral tunnel independently by tibial tunnel, allows us to place femoral tunnel entrance in a position of 10 'clock that can most accurately reproduce the anatomic behaviour of the ACL and can potentially improve the response of the graft to rotatory loads. This positioning results in a more oblique graft placement, avoiding problem related to PCL impingement during knee flexion. Further studies are required to understand if this kind of reconstruction can ameliorate proprioception as well as clinical outcome at a long-term follow-up.
Pubmed
Open Access
Oui
Création de la notice
28/01/2008 13:25
Dernière modification de la notice
20/08/2019 14:33
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