Anterior Cruciate Ligament Surgery Technique Determines Success in Return to Activity for Athletes
Performing the surgery in a Technically correct manner gives my patients the best chance for a well functioning knee after ACL injury. The transition from Transtibial to Anatomic Femoral tunnel drilling started approximately 2008 and by 2013 most surgeons had evolved. Patients that had ACL reconstruction prior to 2008 may be candidates for revision ACL surgery. In 2017 most, but not all ACL surgeons are proficient in the Anatomic Tunnel technique. Outcomes after ACL reconstruction are highly dependent on precisely how the surgery is performed. This blog post is a bit more technical than my average post. This is intended for the lay person who wants to learn about the technical nuances of acl reconstruction of the knee.
The surgical technique used during ACL reconstruction varies widely not only from country to country but even within departments of the same hospital. Surgeons choose from arthroscopic vs open surgery, intra vs extra-articular reconstruction, graft choice, single vs double bundle method and graft fixation. However, all these issue are of secondary importance to FEMORAL TUNNEL and TIBIAL TUNNEL location. An anatomic Femoral Tunnel location created by drilling through an accessory medial arthroscopic portal creates the femoral tunnel in the ideal location. The success of your ACL surgery is most dependent on this tunnel placement. Tibial tunnel placement is also important and should not be placed too far posterior. ACL tunnels that vary outside of these known landmarks result in limited knee motion (tight knee), graft failure by rupture, and graft failure by recurrent instability (even when graft appears “intact” on post op MRI). The explanation for this failure is that the anatomical approach brings the tunnel layouts to a more horizontal position, which is biomechanically better (studies have shown it provides better stability to both anterior-posterior and the internal rotational).Anatomic ACL reconstruction will increase result in better outcomes of in short and the long term for injured athletes.Femoral tunnels created by a transtibial approach will cause the ACL graft to spread outside of the natural adhesion areas and lead to abnormal knee kinematics Anatomic tunnel surgery technique provides better relocation of the graft in terms of kinematics of the knee. Therefore, this technique combined with good rehabilitation has better activity outcomes in terms of sport and regular life compared to the transtibial technique.A clinical study concluded that the use of the anatomic replacement of the ACL resulted in greater knee stability and range of motion values and an earlier return to running compared to the transtibial technique.
