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Study: Individualized anatomic ACL reconstruction can restore more native insertion site area
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BALTIMORE — Individualized anatomic ACL reconstruction can restore a large percentage of the native femoral and tibial insertion site areas, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.
“Anatomic ACL reconstruction should be individualized. To determine the percent of reconstructed area, this is the first step that can quantify how much of the native insertion site is restored following individualized ACL reconstruction,” Kellie K. Middleton, BS, MPH, said in her presentation.
Middleton and colleagues evaluated the use of patient-specific variables to determine the surgical technique, graft type and diameter, as well as tunnel size. Thirty-five patients underwent primary anatomic ACL reconstruction by a single surgeon from May 2011 to November 2011. Intraoperative measurements were insertion site area and tunnel aperture area. Length and width of the native insertion site were measured intraoperatively using an arthroscopic ruler.
 Kellie K. Middleton |
Based on the preoperative plan and intraoperative findings, the single- or double-bundle technique and graft choice for ACL reconstruction was performed to maximize the percentage of reconstructed area of the ACL insertion site, Middleton reported. Insertion site area was calculated using the formula for area of an ellipse.
The team evaluated tunnel aperture on the femoral side with the same technique. On the tibial side, the tunnel aperture area was calculated and accounted for tibial tunnel drill angle and drill diameter. The percentage of reconstructed area for both the femoral and tibial side was calculated by dividing tunnel aperture area by native insertion site area.
Middleton said that the mean area for the native femoral and tibial insertion sites were 87.1 ± 20 mm2 and 133 ± 17 mm2, respectively. On average, the percentage of reconstructed area was 83 ± 14.4% for the femoral side and 68 ± 10.6% for the tibial side.
“This assessment can serve as the basis for comparison to evaluate clinical and surgical outcomes,” she said.
Reference:
Middleton KK, Muller B, Araujo P, et al. Can individualized anatomic anterior cruciate ligament reconstruction restore the native insertion site size? Paper #16. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.
Disclosure: Middleton has no relevant financial disclosures.
