Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction
Date
2019
Type:
Article
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Abstract
Purpose: To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy.
Methods: After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction.
Results: We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability.
Conclusions: With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable.
Level of evidence: Level III, systematic review of Level III evidence.
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Citation
Figueroa D, Calvo R, Vaisman A, Arellano S, Figueroa F, Donoso R, Bernal N, O'Connell LA. Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2019 Nov 11;8(12):e1437-e1441. doi: 10.1016/j.eats.2019.07.022
Keywords
Anterior Cruciate Ligament / anatomy & histology, Anterior Cruciate Ligament / surgery, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction / methods, Femur / anatomy & histology, Femur / surgery, Knee Injuries / surgery, Knee Joint / anatomy & histology, Knee Joint / diagnostic imaging, Posterior Cruciate Ligament / surgery, Reproducibility of Results, Tendons / transplantation, Tibia / anatomy & histology, Tomography, X-Ray Computed