[Reconstruction of the anterior cruciate ligament. Determination of the pre- and peroperative femoral isometric point]

Abstract

This study attempted to determine the femoral isometric site by a simple, reliable and easily reproducible technique for the reconstruction of a torn anterior cruciate ligament (A.C.L.). Anatomoradiological studies showed that the posterior border of the lateral condyle corresponded with the third of a circle and that the center of this circle was named the "isometric point" (F). The variations of the intra-articular length of a ligament between the point F and the center of the A.C.L. tibial attachment did not exceed 2 mm. A radiological study on 50 normal patients knees X-Rayed at 0 degree and 90 degrees of flexion showed a length dependence of 1.5 mm in 84% and 2 mm maximum in 98%. Twenty patients with acute or chronic A.C.L. rupture were operated on; the isometric point F was determined by superimposing a template of circles on the posterior border of the condyle. An original guide allowed to drill a bony tunnel with a pin emerging at the exact previous point F. A per-operative X-Ray studied the good reliability of this guide. The measurements of the variations of length of the ligament between 0 degree and 110 degrees of flexion varied less than 5% in 18 patients, which confirms the good isometry of the reconstruction. On the basis of these data, we propose to improve the implantation of autogenous or synthetic ligament in A.C.L. reconstruction by the use of a pre-operative determination of the isometric femoral point and the use of a guide able to drill easily a bony tunnel at this exact pre-determined point.