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  • Title: A prospective evaluation of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement in anterior cruciate ligament (ACL) reconstruction.
    Author: Werner BC, Burrus MT, Gwathmey FW, Miller MD.
    Journal: Knee; 2016 Jun; 23(3):478-81. PubMed ID: 26549778.
    Abstract:
    BACKGROUND: The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau. RESULTS: The average anteroposterior (A-P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%-49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A-P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%-29.9% (6 patients) or 45.0%-49.9% (10 patients). CONCLUSIONS: Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location. LEVEL OF EVIDENCE: II, Prospective study.
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