The relationship of the femoral attachment site to the isometric tracking of the anterior cruciate ligament graft

Abstract

The large number of reconstructive procedures in the treatment of ACL reflect a lack of consistent clinical success, thus creating the current controversy over the treatment of ACL injuries. The purpose of this study on the relationship of the femoral attachment site to the isometric tracking of the ACL graft was three-fold: 1) to develop a method for evaluating the femoral attach ment site for the ideal isometric graft tracking pattern; 2) to develop a reference table comparing femoral attachment sites to graft excursion; and 3) to apply this information to the surgical procedure to allow for step wise refinement of the attachment site for improved clinical results. To aid in graphic representation, the attachment sites were identified from radiographs by the sclerotic margin of the drill hole in the bone or the bone trough. These attachment sites were transferred to a trace diagram and compiled to form a composite diagram. Three distinct graft tracking patterns were identified. Group I represented the modified "over-the-top" technique with a deep cancellous bone trough and represented the most isometric tracking. Group II represented the mod ified over-the-top technique with a shallow or no can cellous bone trough and Group III the drill hole tech nique. Groups II and III were nonisometric. In surgery, palpation of the graft for excursion while performing a range of motion allows for review of isometric graft tracking. Stepwise intraoperative refine ment of the femoral attachment site can result in iso metric graft tracking.