Surgical and Anatomic Considerations in ACL Reconstruction
Surgical and Anatomic Considerations in ACL Reconstruction
It seems intuitive that placing the ACL graft in its anatomic location would improve knee stability and improve outcomes. Two recent studies evaluating the biomechanics of transtibial drilling and anatomic drilling have confirmed this. Lim et al. performed a cadaver study evaluating anterior tibial translation and anterior tibial translation with internal rotation in ACL reconstructed knees with either anatomic reconstruction or transtibial reconstruction. Their results showed no significant differences among the three groups (anterior tibial translation, anterior tibial translation with internal rotation, and control with intact ACL). However, there was a significant difference found under the combined anterior and internal rotatory force; transtibial ACL reconstructions showed a significant increase in anterior tibial translation compared with anatomic drilling. Driscoll et al. performed a similar study on six fresh frozen cadaver samples evaluating transtibial and anteromedial portal ACL reconstructions. They concluded that anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the anteromedial portal restores translational and rotational knee stability to an extent that closely approximates the ACL intact condition.
Anatomic Drilling Versus Transtibial Drilling: Biomechanical Considerations
It seems intuitive that placing the ACL graft in its anatomic location would improve knee stability and improve outcomes. Two recent studies evaluating the biomechanics of transtibial drilling and anatomic drilling have confirmed this. Lim et al. performed a cadaver study evaluating anterior tibial translation and anterior tibial translation with internal rotation in ACL reconstructed knees with either anatomic reconstruction or transtibial reconstruction. Their results showed no significant differences among the three groups (anterior tibial translation, anterior tibial translation with internal rotation, and control with intact ACL). However, there was a significant difference found under the combined anterior and internal rotatory force; transtibial ACL reconstructions showed a significant increase in anterior tibial translation compared with anatomic drilling. Driscoll et al. performed a similar study on six fresh frozen cadaver samples evaluating transtibial and anteromedial portal ACL reconstructions. They concluded that anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the anteromedial portal restores translational and rotational knee stability to an extent that closely approximates the ACL intact condition.