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Is the native ACL insertion site "completely restored" using an individualized approach to single-bundle ACL-R?
K K Middleton1, B Muller1,2, P H Araujo1,3
1Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.
Individualized anatomic anterior cruciate ligament reconstruction (ACL-R) techniques do not fully restore the native insertion site. This study introduces a method to measure the percentage of reconstructed area, aiding future research on complete footprint restoration.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Anterior cruciate ligament reconstruction (ACL-R) aims to replicate native insertion sites.
- The extent of native footprint restoration by current ACL-R techniques is not well understood.
- Quantifying tunnel aperture area relative to native insertion sites is crucial for evaluating technique efficacy.
Purpose of the Study:
- To determine if individualized anatomic ACL-R maximally fills the native insertion site.
- To establish a metric for evaluating the percentage of reconstructed area.
- To lay the groundwork for understanding the clinical implications of complete footprint restoration in ACL-R.
Main Methods:
- Prospective pilot study of 45 patients undergoing primary single-bundle anatomic ACL-R.
- Intraoperative measurement of native femoral and tibial insertion site dimensions.
- Calculation of native and tunnel aperture areas using elliptical formulas and drill parameters.
- Determination of percentage of reconstructed area by comparing tunnel aperture area to native insertion site area.
Main Results:
- Mean native femoral insertion site area was 83 mm², and tibial was 125 mm².
- Mean femoral tunnel aperture area was 65 mm², and tibial was 86 mm².
- Average reconstructed area was 79% on the femoral side and 70% on the tibial side.
Conclusions:
- Current individualized anatomic ACL-R techniques do not completely restore the native insertion site.
- Percentage of reconstructed area provides a basic measure for assessing native footprint coverage.
- This metric serves as a foundation for investigating the clinical significance of achieving complete footprint restoration in ACL-R.
