High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction
Purpose To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femora...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2019-02, Vol.27 (2), p.611-617 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Smeets, Kristof Bellemans, J. Lamers, G. Valgaeren, B. Bruckers, L. Gielen, E. Vandevenne, J. Vandenabeele, F. Truijen, J. |
| description | Purpose
To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femoral tunnel.
Methods
15 fresh-frozen cadaver knees were examined. An anatomic ACL femoral tunnel was drilled arthroscopically in each specimen and ALL tunnels were made in two directions: (1) 0° coronal angulation and 20° axial angulation, (2) 30° coronal angulation and 30° axial angulation. Computed tomography scans were performed to investigate tunnel convergence and to measure the minimal distance between tunnels, tunnel length and the LFC width.
Results
Tunnel convergence occurred in 20 of 30 cases (67%). Convergence was significantly reduced when tunnels were drilled at 30° coronal and 30° axial angulation (
p
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| doi_str_mv | 10.1007/s00167-018-5200-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2117383318</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2117031177</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-9c057c9eec2688c90aae25ab577120d7e1a8dcdb88e1fdbae0db2324c47db9e63</originalsourceid><addsrcrecordid>eNp1kcFPHCEYxUlT0121f4CXZpJeehn9gJmFOTamrSYmXvRMGPh2i87AFhgT_3tZZ-0mJl6AfO_3HoRHyBmFcwogLhIAXYkaqKxbBlDzT2RJG85rwRvxmSyha1jNoF0tyHFKDwDl2HRfyIID62RD2yXJV27zt4ouPVZhXeXJexwqE_wTxg16g5WdovObMhp759FW2meMLsTKxMk4nbEa3EaP6HOR9nIYyjzq4SBFLJkpF0t2wZ-So7UeEn7d7yfk_vevu8ur-ub2z_Xlz5vaNJLmujPQCtMhGraS0nSgNbJW960QlIEVSLW0xvZSIl3bXiPYnnHWmEbYvsMVPyE_5txtDP8mTFmNLhkcBu0xTEkxSgWXnFNZ0O_v0IcwRV9e90oBL4soFJ0pE0NKEddqG92o47OioHaVqLkSVSpRu0oUL55v--SpH9H-d7x1UAA2A2m7-2qMh6s_Tn0BZS2ZPw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2117031177</pqid></control><display><type>article</type><title>High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals</source><creator>Smeets, Kristof ; Bellemans, J. ; Lamers, G. ; Valgaeren, B. ; Bruckers, L. ; Gielen, E. ; Vandevenne, J. ; Vandenabeele, F. ; Truijen, J.</creator><creatorcontrib>Smeets, Kristof ; Bellemans, J. ; Lamers, G. ; Valgaeren, B. ; Bruckers, L. ; Gielen, E. ; Vandevenne, J. ; Vandenabeele, F. ; Truijen, J.</creatorcontrib><description>Purpose
To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femoral tunnel.
Methods
15 fresh-frozen cadaver knees were examined. An anatomic ACL femoral tunnel was drilled arthroscopically in each specimen and ALL tunnels were made in two directions: (1) 0° coronal angulation and 20° axial angulation, (2) 30° coronal angulation and 30° axial angulation. Computed tomography scans were performed to investigate tunnel convergence and to measure the minimal distance between tunnels, tunnel length and the LFC width.
Results
Tunnel convergence occurred in 20 of 30 cases (67%). Convergence was significantly reduced when tunnels were drilled at 30° coronal and 30° axial angulation (
p
< 0.05). The mean length of the ALL tunnel was 15.9 mm [95% CI (13.6; 18.1)] and was independent of ALL tunnel angulation. The mean minimal distance between the ALL and ACL tunnel was 3.1 mm [95% CI (2.1; 4.1)]. The odds ratio for tunnel convergence was 3.5 for small LFC, relative to large LFC (n.s.)
Conclusion
A high risk of tunnel convergence was observed when performing combined ACL and ALL reconstructions. The clinical relevance of this work is that the occurrence of tunnel conflicts can be reduced by aiming the ALL tunnel in a more proximal and anterior direction. Surgeons should be aware of this, since tunnel convergence could jeopardize the ACL reconstruction and fixation.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-018-5200-3</identifier><identifier>PMID: 30298415</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Anterior cruciate ligament ; Anterior Cruciate Ligament Injuries - diagnostic imaging ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction ; Cadaver ; Computed tomography ; Convergence ; Female ; Femur ; Femur - surgery ; Humans ; Knee ; Knee Joint - surgery ; Ligaments ; Male ; Medical personnel ; Medicine ; Medicine & Public Health ; Orthopedics ; Tomography, X-Ray Computed ; Tunnels</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-02, Vol.27 (2), p.611-617</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-9c057c9eec2688c90aae25ab577120d7e1a8dcdb88e1fdbae0db2324c47db9e63</citedby><cites>FETCH-LOGICAL-c481t-9c057c9eec2688c90aae25ab577120d7e1a8dcdb88e1fdbae0db2324c47db9e63</cites><orcidid>0000-0002-0367-1112</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-018-5200-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-018-5200-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30298415$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smeets, Kristof</creatorcontrib><creatorcontrib>Bellemans, J.</creatorcontrib><creatorcontrib>Lamers, G.</creatorcontrib><creatorcontrib>Valgaeren, B.</creatorcontrib><creatorcontrib>Bruckers, L.</creatorcontrib><creatorcontrib>Gielen, E.</creatorcontrib><creatorcontrib>Vandevenne, J.</creatorcontrib><creatorcontrib>Vandenabeele, F.</creatorcontrib><creatorcontrib>Truijen, J.</creatorcontrib><title>High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femoral tunnel.
Methods
15 fresh-frozen cadaver knees were examined. An anatomic ACL femoral tunnel was drilled arthroscopically in each specimen and ALL tunnels were made in two directions: (1) 0° coronal angulation and 20° axial angulation, (2) 30° coronal angulation and 30° axial angulation. Computed tomography scans were performed to investigate tunnel convergence and to measure the minimal distance between tunnels, tunnel length and the LFC width.
Results
Tunnel convergence occurred in 20 of 30 cases (67%). Convergence was significantly reduced when tunnels were drilled at 30° coronal and 30° axial angulation (
p
< 0.05). The mean length of the ALL tunnel was 15.9 mm [95% CI (13.6; 18.1)] and was independent of ALL tunnel angulation. The mean minimal distance between the ALL and ACL tunnel was 3.1 mm [95% CI (2.1; 4.1)]. The odds ratio for tunnel convergence was 3.5 for small LFC, relative to large LFC (n.s.)
Conclusion
A high risk of tunnel convergence was observed when performing combined ACL and ALL reconstructions. The clinical relevance of this work is that the occurrence of tunnel conflicts can be reduced by aiming the ALL tunnel in a more proximal and anterior direction. Surgeons should be aware of this, since tunnel convergence could jeopardize the ACL reconstruction and fixation.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anterior cruciate ligament</subject><subject>Anterior Cruciate Ligament Injuries - diagnostic imaging</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Anterior Cruciate Ligament Reconstruction</subject><subject>Cadaver</subject><subject>Computed tomography</subject><subject>Convergence</subject><subject>Female</subject><subject>Femur</subject><subject>Femur - surgery</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Ligaments</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Tomography, X-Ray Computed</subject><subject>Tunnels</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kcFPHCEYxUlT0121f4CXZpJeehn9gJmFOTamrSYmXvRMGPh2i87AFhgT_3tZZ-0mJl6AfO_3HoRHyBmFcwogLhIAXYkaqKxbBlDzT2RJG85rwRvxmSyha1jNoF0tyHFKDwDl2HRfyIID62RD2yXJV27zt4ouPVZhXeXJexwqE_wTxg16g5WdovObMhp759FW2meMLsTKxMk4nbEa3EaP6HOR9nIYyjzq4SBFLJkpF0t2wZ-So7UeEn7d7yfk_vevu8ur-ub2z_Xlz5vaNJLmujPQCtMhGraS0nSgNbJW960QlIEVSLW0xvZSIl3bXiPYnnHWmEbYvsMVPyE_5txtDP8mTFmNLhkcBu0xTEkxSgWXnFNZ0O_v0IcwRV9e90oBL4soFJ0pE0NKEddqG92o47OioHaVqLkSVSpRu0oUL55v--SpH9H-d7x1UAA2A2m7-2qMh6s_Tn0BZS2ZPw</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Smeets, Kristof</creator><creator>Bellemans, J.</creator><creator>Lamers, G.</creator><creator>Valgaeren, B.</creator><creator>Bruckers, L.</creator><creator>Gielen, E.</creator><creator>Vandevenne, J.</creator><creator>Vandenabeele, F.</creator><creator>Truijen, J.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0367-1112</orcidid></search><sort><creationdate>20190201</creationdate><title>High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction</title><author>Smeets, Kristof ; Bellemans, J. ; Lamers, G. ; Valgaeren, B. ; Bruckers, L. ; Gielen, E. ; Vandevenne, J. ; Vandenabeele, F. ; Truijen, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-9c057c9eec2688c90aae25ab577120d7e1a8dcdb88e1fdbae0db2324c47db9e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anterior cruciate ligament</topic><topic>Anterior Cruciate Ligament Injuries - diagnostic imaging</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Anterior Cruciate Ligament Reconstruction</topic><topic>Cadaver</topic><topic>Computed tomography</topic><topic>Convergence</topic><topic>Female</topic><topic>Femur</topic><topic>Femur - surgery</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Ligaments</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Tomography, X-Ray Computed</topic><topic>Tunnels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smeets, Kristof</creatorcontrib><creatorcontrib>Bellemans, J.</creatorcontrib><creatorcontrib>Lamers, G.</creatorcontrib><creatorcontrib>Valgaeren, B.</creatorcontrib><creatorcontrib>Bruckers, L.</creatorcontrib><creatorcontrib>Gielen, E.</creatorcontrib><creatorcontrib>Vandevenne, J.</creatorcontrib><creatorcontrib>Vandenabeele, F.</creatorcontrib><creatorcontrib>Truijen, J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smeets, Kristof</au><au>Bellemans, J.</au><au>Lamers, G.</au><au>Valgaeren, B.</au><au>Bruckers, L.</au><au>Gielen, E.</au><au>Vandevenne, J.</au><au>Vandenabeele, F.</au><au>Truijen, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>27</volume><issue>2</issue><spage>611</spage><epage>617</epage><pages>611-617</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
To assess the risk of femoral tunnel convergence in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. The hypothesis was that a more proximal and anterior orientation of the ALL femoral tunnel should reduce the risk of convergence with the ACL femoral tunnel.
Methods
15 fresh-frozen cadaver knees were examined. An anatomic ACL femoral tunnel was drilled arthroscopically in each specimen and ALL tunnels were made in two directions: (1) 0° coronal angulation and 20° axial angulation, (2) 30° coronal angulation and 30° axial angulation. Computed tomography scans were performed to investigate tunnel convergence and to measure the minimal distance between tunnels, tunnel length and the LFC width.
Results
Tunnel convergence occurred in 20 of 30 cases (67%). Convergence was significantly reduced when tunnels were drilled at 30° coronal and 30° axial angulation (
p
< 0.05). The mean length of the ALL tunnel was 15.9 mm [95% CI (13.6; 18.1)] and was independent of ALL tunnel angulation. The mean minimal distance between the ALL and ACL tunnel was 3.1 mm [95% CI (2.1; 4.1)]. The odds ratio for tunnel convergence was 3.5 for small LFC, relative to large LFC (n.s.)
Conclusion
A high risk of tunnel convergence was observed when performing combined ACL and ALL reconstructions. The clinical relevance of this work is that the occurrence of tunnel conflicts can be reduced by aiming the ALL tunnel in a more proximal and anterior direction. Surgeons should be aware of this, since tunnel convergence could jeopardize the ACL reconstruction and fixation.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30298415</pmid><doi>10.1007/s00167-018-5200-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0367-1112</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-02, Vol.27 (2), p.611-617 |
| issn | 0942-2056 1433-7347 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals |
| subjects | Aged Aged, 80 and over Anterior cruciate ligament Anterior Cruciate Ligament Injuries - diagnostic imaging Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction Cadaver Computed tomography Convergence Female Femur Femur - surgery Humans Knee Knee Joint - surgery Ligaments Male Medical personnel Medicine Medicine & Public Health Orthopedics Tomography, X-Ray Computed Tunnels |
| title | High risk of tunnel convergence during combined anterior cruciate ligament and anterolateral ligament reconstruction |
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