ACL Tunnel Reconstruction: How to perform

Last updated on July 6 2022

Description

The anterior cruciate ligament (ACL) reconstruction is a surgery to reconstruct the ligament in the center of the knee. The ACL keeps the tibia in place. A tear of this ligament can cause your knee to give way during physical activity.

ACL tunnel reconstruction can be used to evaluate the position of the femoral tunnel in ACL reconstruction using lateral views. This tool uses the quadrant method with the outside-in technique to determine the localization of the femoral insertion of the ACL, based on Lorenz studies.

Measurements

The measurements made by the procedure are displayed in the image: 

• Anterior length (AL): the anterior distance from the point to place the tunnel;
• Posterior length (PL): the posterior distance from the point to place the tunnel;
• Tunnel Position T 24% (21%, 27%) (TPT): midpoint between the anterior medial (21%) and posterior lateral (27%) points of the T length along the Blumensaat's line (t’);
• Tunnel Position H 33.5% (22%, 45%) (TPH): midpoint between the anterior medial (22%) and posterior lateral (45%) points of distance H from the Blumensaat's line (h’). 

Auxiliary references

To show this procedure, PeekMed® needs additional references:

• Blumensaat's line: a line drawn along the roof of the intercondylar notch of the femur as shown on a lateral radiograph of the knee joint;
• A grid of the quadrant method will be constructed using the distances T and H;
• distance T: total length of the femoral condyle measured along the Blumensaat's line; 
• distance t’: a point placed at 21% of the distance T and 27% of the distance H;
• distance H: total height of the femoral condyle from Blumensaat's line;
• distance h’: midpoint between the anterior medial (22%) and posterior lateral (45%) points of distance H from Blumensaat's line.