Introduction: Drilling of the femoral bone tunnel in anterior cruciate ligament reconstruction may be performed in a transtibial drilling technique or via the anteromedial portal.

Purpose: To determine the accuracy of the radiographic bone tunnel position using either a transtibial or anteromedial drilling technique.

Materials & methods: The postoperative lateral radiographs of 100 patients after anterior cruciate ligament reconstruction were reviewed. In each patient, the femoral bone tunnel was created either through the tibial tunnel or via the anteromedial standard arthroscopy portal. The resulting position of the femoral tunnel was evaluated according to reference values reported by Aglietti (65 % of the cortical femoral A-P distance along Blumenstaat’s line), Amis (60 % of the A-P diameter of the posterior lateral femoral condyle parallel to Blumensaat’s line), and Harner (80 % of the A-P length of Blumensaat’s line). The mean deviation of the radiographic tunnel position from the referenced values was statistically evaluated.

Results: Radiographic bone tunnel positions with transtibial drilling were 62.42 ± 8.36, %, 54.53 ± 8.43 %, and 75.84 ± 9.56 % according to Aglietti, Amis, and Harner, respectively. Bone tunnel positions with anteromedial drilling were 65.46 ± 5.29 %, 59.59 ± 4.18 %, and 79.93 ± 4.24 %, respectively. The mean deviation from the reference values was significantly higher when comparing transtibial to anteromedial drilling. Transtibial drilling resulted in a significantly more anterior bone tunnel position.

Conclusion: Precise bone tunnel placement is a prerequisite for proper postoperative knee function and stability. The results of this study indicate that the accuracy of femoral bone tunnel placement through the anteromedial arthroscopy portal was superior to transtibial drilling. It may therefrore be concluded that drilling the femoral tunnel through the anteromedial portal is recommended when using fixation techniques not depending upon placement of a transtibial guide.

The present study was conducted to analyze the specific morphological features of press-fitted quadriceps tendon-patellar bone grafts that determine primary graft stability in ACL-reconstruction.

Ten quadriceps tendon-patellar bone grafts were harvested from fresh frozen human cadaveric knees (age 52–82) and fixed to porcine femora in a press-fit technique. Four specimens were prepared for histological analysis of the bone-tendon junction, while a modified technique for tissue-plastination was applied to 6 specimens to investigate the microscopic and microradiographic features of the bone-to-bone interface.

Analysis of the bone-tendon junction revealed a serious damage of the fibrocartilage at the attachment zone according to the impaction of the patellar bone plug with implantation. Microradiographs and microscopy of the plastinated specimens showed that there is a trabecular interaction between the bony interfaces of the graft and the femoral tunnel, representing an early osseous integration with local increase of radiopacity. In consequence, both elevated compressive forces as well as increased frictional resistance seem to contribute to the primary stability of press-fit fixated grafts.

The stability of quadriceps tendon-patellar bone grafts in press-fit technique to a certain degree depends on bone quality, allowing compressive forces to arise at the bone-to-bone interface. Loss of graft stability, however, is caused by disturbance of the integrity of the bone-tendon junction while impacting the patellar bone plug into the femoral tunnel.

Aims: The purpose of this study was to verify a partial bursal-side rupture of the rotator cuff (RC) using different imaging techniques with special emphasis on the validity of a specific method of subacromial arthrography (SAA). Methods: Patients (n=92, age 53.8 years) with a subacromial impingement syndrome underwent sonography, magnetic resonance imaging (MRI), and SAA. All diagnostic results were controlled by subsequent arthroscopic surgery. Results: Out of 31 surgically verified ruptures, 17 cases showed a partial rupture located towards the bursa. These had been detected by MRI and ultrasound with a sensitivity of 64% and 41%, respectively, while SAA as a diagnostic tool yielded a sensitivity of 82%. In 14 cases of complete RC ruptures, all imaging techniques had a similar sensitivity of 86 to 93%. Conclusions: It appears that SAA is a sufficient and valid diagnostic tool for the detection of partial bursa-sided RC ruptures. Ultrasound and MRI showed a comparably lower sensitivity. It is therefore concluded that SAA has clear advantages in the diagnosis of this defect with the consequence that open surgical techniques to the patient can be avoided.

Aims: Aim of this study was to asses the glenohumeral joint internal and external range of motion using ultra-sonographic based kinematic measurement. Methods: 27 male professional tennis players were bilaterally measured for internal and external rotation at 90 degrees of shoulder abduction while negating scapulothoracic motion. The normal control group consisted of 20 asymptomatic volunteers. Results: Both arms had signiþcantly greater degrees of external rotation than internal rotation (p< 0,05). The dominant arm (playing arm) had signiþcantly greater range of external rotation than the nondominant arm (p< 0,01). Analysis of internal rotational deþciency showed highly decreased internal rotation on the dominant arm (p< 0,01). The total rotational range of motion of the dominant arm was also found signiþcantly less (p< 0,01) in the elite tennis players. No signiþcant difference was found for the dominant and nondominant extremity in the control group. Conclusions: The objective measurement of glenohumeral rotational abilities has clinical application for the development of a speciþc treatment protocol that may reduce the risk of shoulder injury.