Comparison of second-look arthroscopic evaluations between two femoral tunnel locations in anatomical single-bundle ACL reconstruction

Abstract

Abstract Background Anterior cruciate ligament reconstruction (ACL-R) is the best treatment for anterior cruciate ligament (ACL) rupture, and the most widely used reconstruction technique is single beam reconstruction. One of the most important factors affecting the knee function after ACL-R is the location of the femoral tunnel. Therefore, how to accurately select the femoral tunnel during operation, and how to directly evaluate the integration, tension and synovial coverage of the graft after operation are all difficult problems. The purposes of this study were to determine the best femur tunnel for anterior cruciate ligament reconstruction based on a second-look arthroscopic study. Methods A total of 67 patients who were treated with single-beam ACL-R using allografts in our department between January 2014 and February 2020 ultimately met the inclusion criteria and were contacted for the study. A second-look arthroscopic evaluation was carried out one year after anatomical single-bundle ACL reconstruction. According to the postoperative 3D-CT, the patients were divided into the anatomic anteromedial (AM) group and the anatomic mid-bundle (center-center) group based on the femoral tunnel location. Results In terms of the Lysholm score, a significant difference existed between the groups at the last follow-up evaluation (p < 0.05). The tension of the graft involved was flabby in 2 patients (5.7%) in the center-AM group and 5 patients (15.6%) in the center-center group. Type I (tight cruciate ligament-like structured graft with complete synovial coating) and type II (tight, bundle-like structured graft with incomplete or lacking synovial coating) were found in 33 patients (94.29%) in the center-AM group and 27 patients (84.38%) in the center-center group. The statistical analysis showed a significant correlation between the femoral tunnel position and the arthroscopic evaluation of the grafts according to the Marburger Arthroscopy Score (MAS) (p = 0.02 < 0.05; Χ2 = 7.865). Conclusions Our data demonstrated a significant correlation between the femoral tunnel position, clinical condition, and arthroscopic graft constitution. We found that the anatomic AM bundle position of the graft was better than the anatomic mid-bundle placement after ACL reconstruction.