The Anterior Cartilage Edge of the Lateral Femoral Condyle Medial Wall is a Useful Landmark to Avoid Tunnel Convergence in Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis
Year: 2025
Type: article
Abstract: Background: There is a risk of convergence between the anterior cruciate ligament reconstruction (ACLR) femoral tunnel and the lateral extra-articular tenodesis (LET) tunnel, which may cause damage to the graft and fixation device. Purpose: To develop a simple and safe method for drilling the LET tunnel to avoid convergence between the ACL femoral tunnel and the LET tunnel. Study Design: Descriptive laboratory study. Methods: Three-dimensional computed tomography reconstructed images of 60 knees after ACLR and 10 knees after ACLR and LET between August 2023 and July 2024 were analyzed. The possibility and utility of using the anterior cartilage edge (ACE) of the lateral femoral condyle medial wall as an intra-articular landmark of the LET tunnel exit were analyzed in 60 knees grouped by ACL tunnel diameter: the 7-mm group (n = 20); the 8-mm group (n = 20); and the 9-mm group (n = 20). The safe zone is defined as the area of the LET bone tunnel exit at the medial wall of the lateral condyle of the femur where the 2 bone tunnels do not intersect. In addition, the bone bridge thickness was measured in 10 knees after ACLR and LET. Results: The x-coordinate of the highest point in the cartilage edge was significantly smaller than that of the intersection point between the safe line and the cartilage edge in each group (7-mm group: 57.27 ± 7.32 vs 88.27 ± 6.17; P = .000; 8-mm group: 56.37 ± 6.90 vs 81.10 ± 8.23; P = .000; 9-mm group: 56.05 ± 3.98 vs 70.99 ± 14.85; P = .000). The ACE was beyond the safe zone. The safe zone increased as the ACL bone tunnel diameter decreased. There was no tunnel conflict in all 10 patients who underwent ACLR and LET. The bone bridge thickness ranged from 3.15 to 8.92 mm. Conclusion/Clinical Relevance: To avoid tunnel convergence in ACLR combined with LET, the ACE of the lateral femoral condyle medial wall is a useful landmark to drill the LET bone tunnel.
Authors: Hong-De Wang, Zhiyu Zhang, Ruilan Dai, Qingyang Meng, Shuang Ren, Yiqun Wang, Wenqiang Yan, Yingfang Ao, Cheng Wang
Institution: Peking University Third Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W4414934582