Aim: To evaluate whether a guiding pin for a femoral tunnel could be positioned through the tibial tunnel into the center of the anatomical ACL attachment. Methods: 77 knees underwented arthroscopic ACL reconstruction with hamstrings. The femoral tunnel was drilled through an anteromedial portal at the center of the anatomic insertion at about 10.00 resp.14.00 position. Tibial tunnel (mean diameter 7.55 ± 0.54 mm) was drilled using a guide inserted at 90 degrees of knee flexion. Then, through the tibial tunnel, a 4mm offset femoral drill guide was positioned as close as possible to the femoral tunnel and a 2.5 mm guide wire was drilled. The position of the guide wire was photographed arthroscopically and the deviation was measured as the distance between the center of the femoral tunnel and the guide wire. Results: The mean deviation was 4.50 ± 1.54 mm (p = 0.00000004) In 74 knees (96.1%) the guidewire did not reach the femoral tunnel. Only in 3 knees it reached the superomedial edge of the femoral tunnel. No statistical relationship was found between deviation and tibial tunnel inclination angles or tibial tunnel diameter. Conclusions: Transtibial femoral tunnel drilling does not reach the anatomic site of the ACL insertion, even with larger tibial tunnels (for hamstring grafts up to 8.5 mm). Transtibial tunnel drilling should be replaced by drilling through the anteromedial portal at least for tunnels with diameters < 9 mm.

Aim: To evaluate activity level and remaining symptoms concerning the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLreconstruction) with either ipsilateral or contralateral bone-patellar-tendon graft (BPT-graft). Methods: 100 patients aged from 18 to 49 years (mean 34) having an ACL-reconstruction with BPT-graft (with one bone block) from 1997 to 1999 were included in this study. In 52 of them a BPT-graft from the ipsilateral side was used (Group I). In 48 the contralateral BPT was used (Group II). A questionaire, including Cincinnati-, Tegner-activity score and special questions concerning persisting symptoms at the donor site, such as tenderness, numbness, kneeling pain and knee-walking pain, was sent to all patients. Results: The average Cincinnati Scoring was 85,2 in Group I and 86,3 in Group II. There was no statistical significance in Tegner scoring between the two groups. In Group I, 37,5% of the patients refered local tenderness, 59,6% kneeling pain and 82,65% knee-walking pain. According to contralateral leg in Group II, 37,5% of the patients refered local tenderness, 52% kneeling pain and 62,5% knee-walking pain vs. 8,3%, 25% and 25% respectively in the ACL reconstructed knee. Conclusions: This study showed that there are no benefits if the contralateral BPT graft is used, because all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee if the graft is taken from the contralateral side.

Aim: To compare the donor site morbidity after anterior cruciate ligament (ACL) reconstruction using ipsilateral and contralateral bone-patellar-tendon (BPT) autograft.

Patients and Method: 100 patients underwent ACL- reconstruction with autologous BPT graft between 1997 and 1999. ACL-reconstruction was performed using ipsilateral (n= 52) and contralateral (n= 48) BPT-autograft. The average follow-up was 39,2 months. Donor site morbidity was evaluated by using a questionaire, computerised historical data, KT-2000 measurments, Cincinnati- (CKS) and Tegner-Score.

Results: KT-2000 evaluation showed an average side to side difference of 0,6 mm in both groups. There were no significant differences between the two groups concerning CKS or Tegner-Score. In the ipsilateral donor knee, 59,6% of the patients had local tenderness, 69,2% kneeling-pain, 76,9% knee-walking-pain and 75% numbness. In the contralateral donor knee, 58,3% of the patients had local tenderness, 70,8% kneeling-pain, 70,8% knee-walking-pain and 85,4% numbness. In the ACL reconstructed knee 6,3% had local tenderness,6,3% kneeling-pain, 10,4% knee-walking-pain and 64,6% numbness.

There was one rupture of the patellar tendon and one patient with chronic patellar tendinitis.

Conclusion: The contralateral BPT graft appears to present no advantage over the ipsilateral as all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee and return to activity is not more rapid.

Aim: Our aim was to evaluate the accuracy and reliability of both MRI and CT in estimating the patello-femoral alignement with the TT/TG (tibial tuberosity/trochlear groove) distance in 14 healthy probants.

Method: The TT/TG distance has been estimated in 28 healthy knees of 14 probants, 8 women and 6 men (age: 24 – 42) with a) MRI in an Esaote Arthroscan 0,2 Tesla Tomographer and b) CT in a General Electric Tomographer. This parameter was estimated in both imaging devices, first by overprojecting a tibial axial image through the tibial tuberosity onto an axial image through both femoral condyles and then by measuring the distance between the deepest point of the trochlear groove and the most prominent point of the TT. The parameter has been estimated twice by 3 well trained independent observers. The statistical evaluation was done with an unifactorial analysis of variance (ANOVA).

Results: Our results showed a good reproducibility (> 95%) of the TT/TG measurement in both methods: The intraobserver reliability was in CT, 0,008 ± 0,005mm and in MRI 0,03 ± 0,0017mm respectively. The interob-server reliability was 0,046 for the CT and 0,66 for the MRI. Interesting was that the average value of TT/TG by measuring with MRI (14 mm) was 3 mm less than the one measured with CT (17mm).

Conclusion: We concluded that in spite of the difference of the average values between MRI and CT the evaluation of the TT/TG parameter by means of MRI could be a good method for estimating this parameter thus avoiding radiation uptake.