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Becoming a student of ACL anatomy can improve ACL reconstruction results
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NEW ORLEANS — Speaking before a packed audience at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, here, an orthopedic surgeon said that those performing ACL reconstructions in active individuals today can do a better job with the surgery.
Peter R. Kurzweil, MD, of Long Beach, Calif., discussed the consequences of reconstructing the torn ACL in a vertical fashion, an approach that is commonly used but can turn otherwise successful surgeries into subsequent failures, possibly leading to needless meniscal tears, PCL impingement and other problems.
“The good news is you don’t have to change too much,” he said.
For starters, he suggested moving the femoral tunnel location out of the femoral condylar notch and placing it just a little lower. Making his point, Kurzweil showed on his slides how the native ACL is actually not positioned in the notch, but on the back of the lateral femoral condyle.
Learn from MRIs
Kurzweil made a few other helpful recommendations during his presentation.
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He urged his colleagues to pay close attention to the anatomy at every opportunity they can — even when viewing knees with normal ACLs through the arthroscope, explaining the importance of studying the native femoral and tibial attachments of the ACL and how that can help them at the time of surgery.
Extension views of MRI scans can be useful learning tools, as well. “When you start to look at your MRI scans, you’re going to start learn a lot,” Kurzweil said, noting the anteromedial bundle is bigger and longer than the posterolateral bundle, and an increased knowledge of these ACL structures should improve surgical outcomes.
He noted he does not rely on guides at all for tunnel placement.
“You have to look at the anatomy after you ablate the area and that’s where you put your femoral tunnel.”
Kurzweil is a paid consultant to or employee of Covidien Pierce Surgical Corporation and Orteq and has stock/stock options with Stryker and Zimmer.
- Reference:
Kurzweil PR. Current concepts update on anatomy and biomechanics. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
