Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction–A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.

Research progress on preparation of lateral femoral tunnel and graft fixation in anterior cruciate ligament reconstruction

Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.

Effects of higher femoral tunnels on clinical outcomes,MRI,and second-look findings in double-bundle anterior cruciate ligament reconstruction with a minimal 5-year follow-up

Background:To perform anatomical anterior cruciate ligament reconstruction(ACLR),tunnels should be placed relatively higher in the femoral anterior cruciate ligament(ACL)footprint based on the findings of direct and indirect femoral insertion.But the clinical results of higher femoral tunnels(HFT)in double-bundle ACLR(DB-ACLR)remain unclear.The purpose was to investigate the clinical results of HFT and lower femoral tunnels(LFT)in DB-ACLR.Methods:From September 2014 to February 2016,83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR(group 1,n=37)and LFT-ACLR(group 2,n=46)according to the position of femoral tunnels.Preoperatively and at the final follow-up,clinical scores were evaluated with International Knee Documentation Committee(IKDC),Tegner activity,and Lysholm score.The stability of the knee was evaluated with KT-2000,Lachman test,and pivot-shift test.Cartilage degeneration grades of the International Cartilage Repair Society(ICRS)were evaluated on magnetic resonance imaging(MRI).Graft tension,continuity,and synovialization were evaluated by second-look arthroscopy.Return-to-sports was assessed at the final follow-up.Results:Significantly better improvement were found for KT-2000,Lachman test,and pivot-shift test postoperatively in group 1(P>0.05).Posterolateral bundles(PL)showed significantly better results in second-look arthroscopy regarding graft tension,continuity,and synovialization(P<0.05),but not in anteromedial bundles in group 1.At the final follow-up,cartilage worsening was observed in groups 1 and 2,but it did not reach a stastistically significant difference(P>0.05).No statistically significant differences were found in IKDC subjective score,Tegner activity,and Lysholm score between the two groups.Higher return-to-sports rate was found in group 1 with 86.8%(32/37)vs.65.2%(30/46)in group 2(P=0.027).Conclusion:The HFT-ACLR group showed better stability results,better PL,and higher return-to-sports rate compared to the LFT-ACLR group.