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This Article Full Text Full Text (PDF) All Versions of this Article: 33/5/712    most recent 0363546504271747v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Musahl, V. Articles by Fu, F. H. Search for Related Content PubMed PubMed Citation Articles by Musahl, V. Articles by Fu, F. H. Related Collections Reconstruction Kinematics and kinetics

Varying Femoral Tunnels Between the Anatomical Footprint and Isometric Positions

Effect on Kinematics of the Anterior Cruciate Ligament–Reconstructed Knee

From the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

^* Address correspondence to Freddie H. Fu, MD, Chairman and David Silver Professor, Department of Orthopaedic Surgery, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213 (e-mail: arrisherlm{at}msx.upmc.edu).

Background: Knee kinematics and in situ forces resulting from anterior cruciate ligament reconstructions with 2 femoral tunnel positions were evaluated.

Hypothesis: A graft placed inside the anatomical footprint of the anterior cruciate ligament will restore knee function better than a graft placed at a position for best graft isometry.

Study Design: Controlled laboratory study.

Methods: Ten cadaveric knees were tested in response to a 134-N anterior load and a combined 10-N·m valgus and 5-N·m internal rotation load. A robotic universal force-moment sensor testing system was used to apply loads, and resulting kinematics were recorded. An active surgical robot system was used for positioning tunnels in 2 locations in the femoral notch: inside the anatomical footprint of the anterior cruciate ligament and a position for best graft isometry. The same quadrupled hamstring tendon graft was used for both tunnel positions. The 2 loading conditions were applied.

Results: At 30° of knee flexion, anterior tibial translation in response to the anterior load for the intact knee was 9.8 ± 3.1 mm. Both femoral tunnel positions resulted in significantly higher anterior tibial translation (position 1: 13.8 ± 4.6 mm; position 2: 16.6 ± 3.7 mm; P < .05). There was a significant difference between the 2 tunnel positions. At the same flexion angle, the anterior tibial translation in response to the combined load for the intact knee was 7.7 ± 4.0 mm. Both femoral tunnel positions resulted in significantly higher anterior tibial translation (position 1: 10.4 ± 5.5 mm; position 2: 12.0 ± 5.2 mm; P < .05), with a significant difference between the tunnel positions.

Conclusion: Neither femoral tunnel position restores normal kinematics of the intact knee. A femoral tunnel position inside the anatomical footprint of the anterior cruciate ligament results in knee kinematics closer to the intact knee than does a tunnel position located for best graft isometry.

Clinical Relevance: Anatomical femoral tunnel position is important in reproducing function of the anterior cruciate ligament.

Key Words: active robotic surgery • robotic/universal force-moment sensor (UFS) testing system • anterior cruciate ligament (ACL) reconstruction • femoral tunnel position

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