LIVRE JDG 2012

Importance and Radiographic Identification of the Femoral Insertion…

301

(fig. 3). If this point is deviating obviously or

the cannulated drill is inside the anatomical

insertion area only by 50% (fig. 4), the guide

wire has to be removed and reinserted towards

the desired direction, until an anatomical

positioning is achieved.

Besides the possibility of a very small skin

incision at the femoral side with the maximal

length of the screw diameter, used for the

femoral fixation, the femoral insertion becomes

reproducible and the risk of a non-anatomical

reconstruction can be minimized drastically.

Especially in patients, where the medial aspect

of the distal femur is covered with soft tissue, a

radiological identification of the insertion point

is highly recommended and is simplifying the

operation.

Fig. 3: Intraoperative view by fluoroscope at the

correct position. The insertion point is identified at

the point, where the cannulated drill is attaching

the bone (anterior to the posterior condyle line,

distal to the perpendicular through the inition of

the medial condyle and proximal to the most

posterior point of the Blumensaat line).

Fig. 4: Non anatomical position: the cannulated drill

attaches the bone too far anterior and proximal

Literature

[1] Allen CR, Giffin JR, Harner CD. Revision

anterior cruciate ligament reconstruction.

Orthop Clin North

Am, 34(1): 79-98, 2003.

[2] Amis AA, Firer P, Mountney J, Senavongse

W, Thomas NP. Anatomy and biomechanics of the medial

patellofemoral ligament.

Knee, 10(3): 215-20, 2003.

[3] Bernard M, Hertel P, Hornung H, Cierpinski

T. Femoral insertion of the ACL. Radiographic quadrant

method.

Am J Knee Surg, 10(1): 14-21; discussion 21-2, 1997.

[4] Conlan T, GarthWP J

, Lemons JE. Evaluation of

the medial soft-tissue restraints of the extensor mechanism

of the knee.

J Bone Joint Surg Am, 75(5): 682-93, 1993.

[5] Davis DK, Fithian DC. Techniques of medial

retinacular repair and reconstruction.

Clin Orthop Relat Res,

(402): 38-52, 2002.

[6] Desio SM, Burks RT, Bachus KN. Soft tissue

restraints to lateral patellar translation in the human knee.

Am J Sports Med, 26(1): 59-65, 1998.

[7] Elias JJ, Cosgarea AJ. Technical Errors During

Medial Patellofemoral Ligament Reconstruction Could

Overload Medial Patellofemoral Cartilage: A Computational

Analysis.

Am J Sports Med, 2006.

[8] Ellera Gomes JL, Stigler Marczyk LR,

Cesar de Cesar P, Jungblut CF. Medial

patellofemoral ligament reconstruction with semitendinosus

autograft for chronic patellar instability: a follow-up study.

Arthroscopy, 20(2): 147-51, 2004.

[9] Hautamaa PV, Fithian DC, Kaufman KR,

Daniel DM, Pohlmeyer AM. Medial soft tissue

restraints in lateral patellar instability and repair.

Clin

Orthop, (349): 174-82, 1998.