5 Points on Rationale for Strategic Graft Placement in Anterior Cruciate Ligament Reconstruction I.D.E.A.L. Femoral Tunnel Position

摘要

In the United States, surgeons perform an estimated 200,000 anterior cruciate ligament reconstructions (ACLRs) each year. Over the past decade, there has been a surge in interest in defining anterior cruciate ligament (ACL) anatomy to guide ACLR. With this renewed interest in the anatomical features of the ACL, particularly the insertion site, many authors have advocated an approach for complete or near-complete "footprint restoration" for anatomical ACLR. Some have recommended a double-bundle (DB) technique that completely "fills" the footprint, but it is seldom used. Others have proposed centralizing the femoral tunnel position within the ACL footprint in the hope of capturing the function of both the anteromedial (AM) and posterolateral (PL) bundles. Indeed, a primary surgical goal of most anatomical ACLR techniques is creation of a femoral tunnel based off the anatomical centrum (center point) of the ACL femoral footprint. With a single-bundle technique, the femoral socket is localized in the center of the entire footprint; with a DB technique, sockets are created in the centrums of both the AM and PL bundles.