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Tibial bone tunnel position after ACL reconstruction associated with graft-wall impingement
After anatomic double-bundle ACL reconstruction, the probability of graft-wall impingement was associated with positions of the femoral and tibial bone tunnel in both the sagittal and coronal orientations, according to study results.
Researchers assessed the rate of wall impingement in 51 patients who underwent primary anatomic double-bundle ACL reconstruction, defining graft-wall impingement as overlap between the lateral wall of the notch and the line connecting each center of the intra-articular apertures of the femoral and tibial bone tunnels.
The researchers compared parameters for bone tunnel positioning in the femur and tibia, notch width index and knee joint rotation angle between patients with and without wall impingement and assessed the most important risk factors for wall impingement by logistic regression analysis.
Although no patients exhibited wall impingement for the posterolateral bundle, the researchers observed wall impingement for the anteromedial bundle in 42% of knees.
Patients who were positive for impingement had the anteromedial bundle bone tunnel with the femoral bone placed significantly higher and the tibial tunnel significantly more anteriorly and laterally compared with patients who were negative for impingement, according to the researchers.
Study results showed there was a 100% incidence of wall impingement among bone tunnels positioned 48% to 50% from the medial border of the tibia. Logistic regression analysis showed lateral deviation of the anteromedial bundle tibial bone tunnel was significantly associated with wall impingement, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.