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RESEARCH PRODUCT
How to avoid collision between PCL and MCL femoral tunnels during a simultaneous reconstruction.
Michele D'arienzoEmanuele GrassedonioMassimo MidiriLawrence CamardaMichele Lauriasubject
Models Anatomicmedicine.medical_specialtyMCL PCLKnee JointMedial Collateral Ligament KneeMCL PCL reconstruction combined ligament reconstruction collision tunnelPosterior Cruciate Ligament ReconstructionKnee InjuriesCondyle03 medical and health sciences0302 clinical medicineSettore MED/33 - Malattie Apparato LocomotoremedicineHumansOrthopedics and Sports MedicineFemurFemurCombined ligament reconstruction030222 orthopedicsMedial collateral ligamentbusiness.industryMultiple ligament reconstructionPosterior Cruciate Ligament ReconstructionMedial colateral ligament030229 sport sciencesCollisionMedial collateral ligament reconstructionmedicine.anatomical_structureCoronal planePosterior cruciate ligamentOrthopedic surgerySurgeryPosterior Cruciate LigamentNuclear medicinebusinessdescription
PURPOSE: The purpose of the present study was to assess the risk of femoral tunnel collisions between the medial collateral ligament (MCL) and the posterior cruciate ligament (PCL) tunnels during a simultaneous PCL and MCL reconstruction. METHODS: Fourth generation medium and large synthetic femur bones were used. On each femur, a MCL tunnel and a PCL tunnel were reamed. The MCL tunnel was drilled at 0°, 20° and 40° of axial and coronal angulations. The PCL femoral tunnel was reamed to simulate two different tunnel directions that could be obtained through an inside-out and outside-in technique. Tunnels were filled with epoxy resin augmented with BaSO4, and a multidetector CT examination of each specimen was performed. RESULTS: High rate of tunnel collision (62.5 %) was found when the MCL femoral tunnel was reamed with a coronal angulation of 0° and 20°. The rate of tunnel collision significantly decreased (0 %) when the MCL tunnel was reamed proximally with a coronal angulation of 40°. No differences were found between the two PCL tunnel directions in terms of tunnel collision. CONCLUSION: The results of this study can help surgeons to better direct the femoral MCL tunnel in order to avoid a collision between femoral tunnels during a combined MCL and PCL reconstruction. In order to minimize such potential complications, the MCL tunnel should be created limiting the axial angulation and it should be drilled with a proximal angulation from 20° to 40°, depending on the medial condyle width.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2014-11-28 | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |