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KMID : 0359619930050020138
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Journal of Korean Knee Society
1993 Volume.5 No. 2 p.138 ~ p.144
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Tibial Tunnel Placement in Anterior Cruciate Ligament Resconstructions and Roof Impingement
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Abstract
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roof impingement occurs when the tibial tunnel is anterior to the slope of the intercondylar roof in the maximally extended knee. The tibial location of the graft must be correct so that it will full range of motion with no impingement, and
fanterior
stability, all of which can be checked and assumed intraoperatively. The purpose of this study is to determine the ideal tibial placement of the graft without an impingement in order to avoid graft stretch-out and flexion contractures by
reviewing
the
cases of the ACL reconstruction retrospectively.
Twelve anterior cruciate ligament (ACL) reconstructions took a magnetic scan of the ACL graft one year after the operation. Seven impingement-free grafts had a low magnetic resonance signal form the origin to the insertion. Five impinged grafts
had
an
increased magnetic resonance signal confined to the distal two thirds of the graft. The location of the tibial tunnel was determined from a lateral roentgenogram.
An MR study of the normal ACL insertion of normal knees showed that the center of tibial attachment site was 35.3% (20.4 mm) from the anterior edge of the tibial plateau. When the tibial tunnel was centered within a 6.2 mm imopingement-free zone
(21.0 ~
27.2 mm from the anterior edge of the tibia), the knees were more stable and full extension was obtained. In conclusion, the ideal center of the tibial tunnel in ACL reconstruction is the site 1.9 mm posterior to the center of the original ACL
insertion.
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KEYWORD
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