Tunnel Roof Reconstruction

The if technique had no specimens with roof impingement despite an anterior tibial tunnel position likely due to a more horizontal graft trajectory and anatomic placement of the acl femoral tunnel.

Tunnel roof reconstruction. Case discussion graft position in acl reconstruction is crucial to mimic the biomechanics of the original acl. Roof impingement remains a concern after tt acl reconstruction in the setting of anterior tibial tunnel placement although statistical. Preventable complications such as anterior knee pain effusions extension loss and recurrent instability can occur when the tibial tunnel is improperly placed and the roof and notchplasty are insufficient. Other complications of acl reconstruction include roof impingement postoperative stiffness tunnel widening due to cyst formation iliotibial band friction syndrome hardware failure and infection.

Magnetic resonance mr imaging is the preferred advanced imaging modality for the evaluation of symptomatic acl graft reconstructions 6 7. The common complications of acl plasty include shearing of the graft due to mechanical impingement roof impingement development of cysts within the fixation tunnel complications from the fixation materials migration fragmentation bone reaction with irritation for example of the tibial band etc and finally infection. The tibial tunnel should be posterior and parallel to the roof of the intercondylar notch depicted by the blumensaat line in this case it is also anteriorly placed. Roof impingement occurs when an acl graft prematurely contacts the intercondylar roof before the knee reaches terminal extension figure 1.

Reconstruction of a torn anterior cruciate ligament acl cannot be successful without a properly placed tibial tunnel. To avoid roof impingement howell advised surgeons to place the tibial tunnel about 4 mm or 5 mm posterior to the roof with the knee in full extension and place the graft without doing a roofplasty. Impingement syndrome occurs where the relationships between two articular. The inferior portion of the tunnel should be located at the intersection of these two lines 12 14 figs.

The normal tibial tunnel should be parallel and posterior to the slope of the intercondylar roof on sagittal images 5a. Other complications of acl reconstruction include roof impingement postoperative stiffness tunnel widening due to cyst formation iliotibial band friction syndrome hardware failure and infection. This article reviews the principles for anatomic placement of the. Placement of the tunnel too far posteriorly may lead to instability of the knee and placement too far forward results in roof impingement.

The most important predictor of clinical outcome in the anterior cruciate ligament acl reconstruction is tunnel placement 1.