Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery - A cadaveric study.

Abstract

The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. Twelve single knee cadavers were used, 6 for a single bundle ACL reconstruction, which were reamed gradually starting from 8 mm, 9 mm and ended with a 10 mm reamers, while the other 6 were prepared for a double bundle ACL reconstruction in which 7 mm reamer for the AM tunnel and 6 mm reamer for the PL tunnel were used. After drilling, changes of lengths and thicknesses of anterior horns of the lateral menisci were recorded. Before drilling, the groups were homogenous for the lateral menisci dimensions. After drilling, no statistically significant difference was noticed between the two groups. However, in single bundle group, 2 anterior horns width injury (1.44 mm and 2.13 mm) with the 9 mm reamer and 3 anterior horns width injury (2.51 mm, 3.55 mm and 4.28 mm) with the 10 mm reamer were recorded. However in double bundle group a single anterior horn width injury (2.82 mm) was recorded. Using a greater size reamer in single bundle reconstruction, causes a relatively higher risk of lateral meniscal anterior root injury. Lateral meniscus stability should be examined arthroscopically after reaming with large reamers.