Study finds, Non-anatomic tunnel position increases the risk
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Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure. The purpose of this study was to determine if non-anatomic femoral tunnel placement is associated with increased risk of revision ACL-R.

From a group of 456 consecutive revision ACL-R, patients were screened for strictly lateral radiographs and 59 patients were included in the revision group. Femoral tunnel placement for each patient was determined using a strict lateral radiograph taken after the primary ACL-R using the quadrant method.

The center of the femoral tunnel was measured in both the posterior–anterior (PA) and proximal–distal (PD) dimensions and represented as a percentage of the total distance (normal center of anatomic footprint: PA 25% and PD 29%).

Results:
--In the PA dimension, the revision group had significantly more anterior femoral tunnel placement compared with the primary group.

--Among patients who underwent revision; those with non-traumatic chronic failure had statistically significant more anterior femoral tunnel placement than those who experienced traumatic failure.

--In the PD dimension, the revision group had significantly more proximal femoral tunnel placement compared with the primary group.

Finally, anterior and proximal (high) femoral tunnels for ACL-R were found to be independent risk factors for ACL revision surgery in this retrospective review of 58 patients with effective primary ACL-R compared to 59 patients with failed ACL-R. Since revision ACL-R is correlated with increased patient and financial pressure, achieving an individualized, anatomic primary ACL-R should be prioritized. By positioning the core of the femoral tunnel inside the anatomic ACL footprint, surgeons may reduce the risk of revision ACL-R.

Source: https://link.springer.com/article/10.1007/s00167-021-06607-7
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