Mid-bundle positioning of the femoral socket increases graft rupture in anatomic single bundle anterior cruciate ligament reconstruction.
Abstract
BACKGROUND: Anatomic anterior cruciate ligament (ACL) reconstructions are superior to non-anatomic graft placements with regard to controlling rotational laxity. Different techniques of anatomic single-bundle reconstruction exist. The femoral tunnel may be placed in a mid-bundle position (MB) or within the anteromedial bundle footprint (AM) with no definitive consensus as to the preferred position. Our institution, reflecting trends in surgical practice, has experience with both techniques. METHODS: Interrogation of our prospectively maintained database yielded all primary ACL reconstructions performed using the anatomic TransLateral single-bundle all-inside technique. A two year minimum follow-up was set. The failure rate of the MB and AM cohorts was compared as a primary outcome. Patient-reported outcomes across cohorts at several time-points were analysed as a secondary outcome. RESULTS: Two hundred and seventy-nine primary ACL reconstructions were identified at a median follow-up of 49 months. MB positioning was utilised in 113 cases (40.5%) and AM positioning in 166 (59.5%). There were significantly more failures in the MB cohort (p = 0.029). Logistic regression revealed mid-bundle femoral positioning was associated with greater than fourfold increase in graft failure (odds ratio 4.14, p = 0.039). CONCLUSION: Data from this case series suggests that amongst anatomic single-bundle ACL reconstructions, grafts with a mid-bundle femoral tunnel are more than four times more likely to fail versus those with a femoral tunnel placed four millimetres deeper within the anteromedial bundle footprint.
Author
Citations
Altmetric:
Date
2018-09
Type
Article
Subject
Orthopaedics
Collections
Citation
Knee. 2018 Sep 14. pii: S0968-0160(18)30699-9. doi: 10.1016/j.knee.2018.08.007. [Epub ahead of print]
Journal / Source Title
DOI
PMID
Publisher
Publisher’s URL
Publisher’s statement
Author(s) Pre or Post Print Version Only. No PDF