Discussion
- femoral tunnel
- tibial tunnel:
- isometric placement of ACL refers to the concept that a full range of knee can be achieved w/o causing long-term ligament deformation;
- isometry can not exist because, during ROM, there is no one point on femur that maintains a fixed distance from a single point on tibia;
- elongation always will occur;
- placement of graft as closely as possible to centers of tibial & femoral attachments of anterior medial band results in least amount of strain (least change in length of ACL during complete ROM of knee);
- many researchers have tried to determine which bundle regions of ACL are most isometric;
- bone patellar bone grafts attempted replacement of anteromedial band of ACL, which is most nearly isometric portion of the normal structure;
- of note, most surgeons feel that it is more important to replace the more non-isometric posterolateral band;
- ACL graft should pull up into the tibial tunnel by about 2-3 mm with extension when fixed on the femoral side;
- this represents the closest reconstitution of the ACL's "physiometry";
- a graft that tightens (pulls up into tibial tunnel) w/ flexion will have a much higher likelyhood of failure and usually indicates a femoral tunnel too far anterior in notch.
- Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations.
- Further observations on the isometricity of the anterior cruciate ligament. An anatomical study using a 6-mm diameter replacement.
- Anterior cruciate ligament reconstruction stability with continuous passive motion. The role of isometric graft placement.
- Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament.
- An In Vivo Comparison between Intraoperative Isometric Measurement and Local Elongation of the Graft after Reconstruction of the Anterior Cruciate Ligament.
- Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement.
- Effect of the Angle of the Femoral and Tibial Tunnels in the Coronal Plane and Incremental Excision of the Posterior Cruciate Ligament on Tension of an Anterior Cruciate Ligament Graft: An in Vitro Study.
- Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement
- Nonanatomic Tunnel Position in Traditional Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction Evaluated by Three-Dimensional Computed Tomography
- Anatomical single-bundle anterior cruciate ligament reconstruction with a transtibial technique.
- Anatomic Graft Placement in ACL Surgery: Plain Radiographs Are All We Need
- Impact of Tibial and Femoral Tunnel Position on Clinical Results After Anterior Cruciate Ligament Reconstruction
- The Lateral Tibial Tunnel in Revision Anterior Cruciate Ligament Surgery: A Biomechanical Study of a New Technique.
- Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results.