Evaluating the distance between the femoral tunnel centers in anatomic double-bundle anterior cruciate ligament reconstruction using a computer simulation

PURPOSE We aimed to clarify the distance between the anteromedial (AM) bundle and posterolateral (PL) bundle tunnel-aperture centers by simulating the anatomical femoral tunnel placement during double-bundle anterior cruciate ligament reconstruction using 3-D computer-aided design models of the knee, in order to discuss the risk of tunnel overlap. Relationships between the AM to PL center distance, body height, and sex difference were also analyzed. PATIENTS AND METHODS The positions of the AM and PL tunnel centers were defined based on previous studies using the quadrant method, and were superimposed anatomically onto the 3-D computer-aided design knee models from 68 intact femurs. The distance between the tunnel centers was measured using the 3-D DICOM software package. The correlation between the AM-PL distance and the subject's body height was assessed, and a cutoff height value for a higher risk of overlap of the AM and PL tunnel apertures was identified. RESULTS The distance between the AM and PL centers was 10.2±0.6 mm in males and 9.4±0.5 mm in females (P<0.01). The AM-PL center distance demonstrated good correlation with body height in both males (r=0.66, P<0.01) and females (r=0.63, P<0.01). When 9 mm was defined as the critical distance between the tunnel centers to preserve a 2 mm bony bridge between the two tunnels, the cutoff value was calculated to be a height of 160 cm in males and 155 cm in females. CONCLUSION When AM and PL tunnels were placed anatomically in simulated double-bundle anterior cruciate ligament reconstruction, the distance between the two tunnel centers showed a strong positive correlation with body height. In cases with relatively short stature, the AM and PL tunnel apertures are considered to be at a higher risk of overlap when surgeons choose the double-bundle technique.