Femoral Graft-Tunnel Angles in Posterior Cruciate Ligament Reconstruction: Analysis with 3-Dimensional Models and Cadaveric Experiments.
10.3349/ymj.2013.54.4.1006
- Author:
Sung Jae KIM
1
;
Yong Min CHUN
;
Sung Hwan KIM
;
Hong Kyo MOON
;
Jae Won JANG
Author Information
1. Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea. orthohwan@gmail.com
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Posterior cruciate ligament;
reconstruction;
graft-tunnel angle;
3-dimensional
- MeSH:
Cadaver;
Femur/radiography/surgery;
Humans;
*Imaging, Three-Dimensional;
Knee Joint/surgery;
Models, Anatomic;
Posterior Cruciate Ligament/radiography/*surgery;
Reconstructive Surgical Procedures/*methods;
Tibia/radiography/surgery;
Tomography, X-Ray Computed
- From:Yonsei Medical Journal
2013;54(4):1006-1014
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft. MATERIALS AND METHODS: Twelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0degrees, 45degrees, 90degrees, and 120degrees). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees. RESULTS: Between 45degrees and 120degrees of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p<0.001). In cadaveric experiments using pressure-sensitive film, the maximum contact pressure for the modified inside-out and outside-in technique was significantly lower than that for the conventional inside-out technique (p=0.024 and p=0.017). CONCLUSION: The conventional inside-out technique results in a significantly lesser GTA and higher stress at the intra-articular aperture of the femoral tunnel than the outside-in technique. However, the results for the modified inside-out technique are similar to those for the outside-in technique.
