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Knee Surg Sports Traumatol Arthrosc (2013) 21:664670 DOI 10.1007/s00167-012-2014-6
KNEE
Graft impingement in anterior cruciate ligament reconstruction
Takanori Iriuchishima Kenji Shirakura
Freddie H. Fu
Received: 16 February 2012 / Accepted: 12 April 2012 / Published online: 25 April 2012 Springer-Verlag 2012
Abstract Anterior cruciate ligament (ACL) graft impingement is one of the most troubling complications in ACL reconstruction. In the previous strategy of isometric non-anatomical ACL reconstruction, posterior tibial tunnel placement and notchplasty were recommended to avoid graft impingement. Recently, the strategy of ACL reconstruction is shifting towards anatomical reconstruction. In anatomical ACL reconstruction, the potential risk of graft impingement is higher than in non-anatomical reconstruction because the tibial tunnel is placed at a more anterior portion on the tibia. However, there have been few studies reporting on graft impingement in anatomical ACL reconstruction. This study will provide a review of graft impingement status in both non-anatomical and the more recent anatomical ACL reconstruction techniques. In conclusion, with the accurate creation of bone tunnels within ACL native footprint, the graft impingement might not happen in anatomical ACL reconstruction. For the clinical relevance, to prevent graft impingement, surgeons should pay attention of creating correct anatomical tunnels when they perform ACL reconstruction.
Level of evidence IV.
Keywords Anterior cruciate ligament Reconstruction
Impingement Roof Anatomical Double bundle
AbbreviationsACL Anterior cruciate ligament AM Antero-medialPCL Posterior cruciate ligament PL Postero-lateral
Introduction
Graft impingement is one of the most serious concerns for surgeons performing anterior cruciate ligament (ACL) reconstruction [15, 16]. When the reconstructed ACL graft is misplaced in the knee, the graft is impinged to the intercondylar roof of the femur, the posterior cruciate ligament (PCL) and other structures during range of knee motion [15]. It is believed that graft impingement could be the cause of anterior knee pain, knee effusion and loss of range of knee motion [21]. Continuous graft impingement can cause graft deterioration or re-rupture and nally result in consistent knee instability [8, 9]. Therefore, avoiding graft impingement is essential in obtaining optimal clinical results after ACL reconstruction.
Strategies of ACL reconstruction have changed within the past decade [32, 36]. Historically, ACL reconstruction was performed as a single-bundle reconstruction until the 1990s [10]. In the single-bundle technique, one ACL graft had to be tightened in the whole...