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SUMMARY
Introduction
The outcome of ACL (anterior cruciate
ligament) reconstruction relates directly to the
positioning of the graft and therefore the
positioning of the tunnels. When drilling the
femoral tunnel (FT), the use of in-out tech
niques with standard rigid instrumentation via
an antero-medial portal may result in a
perforation of the posterior cortex, cause
common peroneal nerve damage and produce
a femoral tunnel that is too short. To correctly
antevert the femoral tunnel and therefore
limit such risks, flexing the knee more than
110° is recommended, which, in turn, may
cause potential surgical problems. Flexible
instrument technology is supposed to require
less knee flexion than the antero-medial portal
to position the anatomic femoral tunnel with
greater length and with less potential for
injury compared with rigid instrumentation.
The goal of our study was to evaluate this
ability. For this reason we compared the
anteversion and length of the FT drilled
via
an
antero-medial portal using a rigid system with
a knee flexion of 120° and a flexible system
with a 90° flexion.
Population and method
We conducted a prospective, comparative and
randomised study on a population of 86
individuals having undergone single-bundle
ACL reconstruction surgery, performed by a
single surgeon, using two techniques to drill
the femoral tunnel: the first technique used
rigid instrumentation with the knee flexed at
120° (Rigid Population); the second technique
used flexible instrumentation with the knee
flexed at 90° (Flexible Population). We
compared the morphometric features of these
two populations (size, gender), the length of
the femoral tunnel measured during the
operation and the positioning of the femoral
tunnel measured on post-operative X-rays.
Results
The Flexible and Rigid Populations were
comparable (no significant differences) in
terms of:
- number
(Rigid: n=37; Flexible: n=43),
- sex
(Rigid and Flexible: 67% men and 33%
women),
- height of individuals
(Rigid: mean = 174cm
[162-190] ; Flexible: mean = 176cm [158-194]),
ANTEVERSION AND LENGTH OF
THE FEMORAL TUNNEL IN ACL
RECONSTRUCTION: Comparison
between rigid and flexible
instrumentation
F. WEIN