Neurovascular risk of bicortical tibial drilling for screw and spiked washer fixation of soft-tissue anterior cruciate ligament graft |
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| Institution: | 1. Tufts University School of Medicine, Boston, MA, USA;2. Division of Joint Replacement Surgery, Maine Medical Center, Portland, ME, USA;3. Department of Rehabilitation, Maine Medical Center, Portland, ME, USA;4. Department of Physical Medicine and Rehabilitation, Maine Medical Center, Portland, ME, USA;1. Motion Analysis Laboratory, Shriners Hospitals for Children, 1275 Fairfax Rd., Salt Lake City, UT 84103, USA;2. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA;3. Walter E. Griffin and Agnes M. Griffin Motion Analysis Laboratory, Shriners Hospitals for Children, 911 W. 5th, Spokane, WA 99204, USA;1. Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant Andrea Hospital, University of Rome Sapienza, Rome, Italy;2. Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, U.S.A.;1. St. Pölten University of Applied Sciences, Department of Physiotherapy, Austria;2. University of Vienna, Department of Biomechanics, Kinesiology and Applied Computer Science, Austria;3. Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Austria;4. Orthopaedic Hospital Vienna-Speising, Laboratory of Gait and Movement Analysis, Austria |
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| Abstract: | Purpose: As the use of soft-tissue anterior cruciate ligament (ACL) grafts, including hamstring grafts, has become more prominent and the benefits of aggressive rehabilitation have become clear, maximizing fixation with screw and spiked washers is important. Bicortical fixation may be superior. We were concerned about potential neurovascular risks and designed this study to define the posterior neurovasculature structures at risk when drilling for bicortical tibial screw fixation during ACL reconstruction. Type of Study: Consecutive sample. Methods: We placed the tibial tunnel arthroscopically in 10 cadaveric knees using a standard tibial drill guide. Accurate tibial tunnel position was documented in each knee by lateral radiograph. A 4.5-mm bicortical drill hole was placed perpendicular to the tibial surface 1 cm distal to the tibial tunnel. The distances from the posterior tibial drill exit point to nearby neurovascular structures were measured with a caliper. Results: The closest structure to the exit point was the bifurcation of the popliteal artery/vein (11.4 ± 0.6 mm; range, 8.4 to 14.0 mm). The next closest was the anterior tibial vein (11.7 ± 1.6 mm; range, 3.5 to 22.8 mm). The closest any individual hole came to a neurovascular structure was 3.5 mm from the anterior tibial vein. Conclusions: Bicortical drilling for fixation of soft tissue grafts appears reasonably safe. The structures at greatest risk for injury are the bifurcation of the popliteal artery/vein and the anterior tibial vein.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 244–247 |
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