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Far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction: a cadaveric study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify the relationship between knee flexion angle and femoral tunnel length, as well as the exit points of guidewires, when using a far anteromedial portal technique for posterolateral femoral tunnel drilling in double-bundle anterior cruciate ligament reconstruction.

Methods

Using the far anteromedial portal technique in 8 cadaveric knees, femoral tunnel drilling for the posterolateral bundle was performed at 3 knee flexion angles: 90°, 110° and 130°. We measured the femoral tunnel length and the distances from each guidewire to the closest relevant structures.

Results

The mean tunnel length at 90° knee flexion (25.8 ± 1.8 mm) was significantly shorter than the length at 110° and 130° knee flexion (32.1 ± 2.6 and 33.1 ± 2.5 mm, respectively). The average distance between the exit point of the guidewire and the posterior articular cartilage of the lateral femoral condyle was the shortest at 90° knee flexion (3.3 ± 2.2 mm). The distance between the guidewire and the centre of the origin of the lateral collateral ligament was the shortest at 130° knee flexion (8.0 ± 1.8 mm). The guidewires penetrated the origin of the lateral gastrocnemius tendon in 2 cases at 110° knee flexion and in 1 case each at 90° and 130° knee flexion.

Conclusions

When using the far anteromedial portal technique, more than 110° knee flexion is desirable to achieve ideal femoral tunnel length and avoid articular cartilage injury. In addition, the risk of damage to the origin of the lateral collateral ligament increases when the knee flexion angle increases to 130°. A knee flexion angle between 110° and 120° was recommended when using the far anteromedial portal technique.

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Acknowledgments

The authors wish to thank Professor Hirohiko Aoyama, Ph.D., from the Department of Anatomy and Developmental Biology, Institute of Biomedical & Health Sciences, Hiroshima University, for allowing us to perform this cadaveric study in his department and for providing us with the facilities to conduct the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Atsuo Nakamae, Mitsuo Ochi, Nobuo Adachi, Masataka Deie, Tomoyuki Nakasa, Goki Kamei, Atsushi Okuhara, Takuya Niimoto & Shingo Ohkawa

  2. Department of Physical Therapy and Occupational Therapy Sciences, Graduate School of Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Masataka Deie

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  1. Atsuo Nakamae
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  2. Mitsuo Ochi
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  4. Masataka Deie
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  5. Tomoyuki Nakasa
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  9. Shingo Ohkawa
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Correspondence to Atsuo Nakamae.

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Nakamae, A., Ochi, M., Adachi, N. et al. Far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 22, 181–187 (2014). https://doi.org/10.1007/s00167-012-2346-2

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  • DOI: https://doi.org/10.1007/s00167-012-2346-2

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