Abstract
Background
Tibial footprint of anterior cruciate ligament (ACL) is situated close to the anterior
lateral meniscal root (ALMR) attachment.
Purpose
To investigate the impact of the size and location of the tibial tunnel for ACL reconstruction
on the ACL footprint coverage and overlap to the ALMR.
Study design
Controlled laboratory study.
Methods
Twenty knee MRI scans from twenty healthy subjects were recruited, and three-dimensional
(3D) tibia models were created to show the tibial attachment sites of ACL and ALMR.
Surgical simulation of the tibial tunnel drilling was performed on each 3D model,
entering the joint at an angle set at 60 degrees from the tibial plateau plane and
55 degrees from the posterior tibial condylar axis, with analysis for six different
drill sizes; 7.5, 8, 8.5, 9, 9.5 and 10 mm; and nine locations; the center of the
ACL attachment and eight locations 2% of the tibial width apart surrounding it. The
width of the tibial plateau, the distance between ACL and ALMR attachment centers,
and the size and location of the potential tibial tunnel were evaluated to determine
association with the area of the ACL footprint coverage and ALMR overlap using a linear
mixed effects model.
Results
A large tunnel (p <.001), a central and anterior location (p <.029), and small tibial width (p =.015) were all associated with larger coverage of the ACL footprint. A large tunnel
(p <.001), posteriorly and laterally located (p ≤ 0.001), and a small distance between the ACL and ALMR centers (p =.001) were significantly associated with a larger ALMR overlap. The association
of the tunnel size to ALMR overlap reduced with a medial tunnel location.
Conclusions
The short distance between the centers of the ALMR attachment and native ACL footprint
suggests that the ALMR will always be susceptible to overlap when the tibial tunnel
is drilled in ACL reconstruction. Small alterations in tunnel location can lead to
a statistically significant alteration with the amount of ALMR overlap. To minimize
this overlap, whilst maintaining acceptable coverage of the ACL footprint, a tibial
tunnel positioned in a medial or anteromedial location from the center of the ACL
footprint is recommended.
Keywords
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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 8,
2022
Received in revised form:
October 13,
2022
Received:
February 2,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
