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The Journal of Bone and Joint Surgery, Vol 75, Issue 7 1044-1055, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof
SM Howell and MA Taylor
Department of Orthopedics (SGHT), David Grant Medical Center, Travis Air Force Base, California 94535-5300.
The relationship between impingement of the roof of the intercondylar notch
on a reconstructed anterior cruciate ligament, and the subsequent stability
and range of extension of the joint, was analyzed in forty-seven knees. The
extent of the impingement was determined by analysis of the relationship of
the tibial tunnel to the intersection of the line of slope of the
intercondylar roof with the plane of the subchondral bone of the articular
surface of the tibial plateau. These lines were drawn on a lateral
roentgenogram that was made with the knee in maximum extension, two years
after the operation. In all four knees in which the entire articular
opening of the tibial tunnel was anterior to the slope of the intercondylar
roof, there was severe impingement on the graft, and all four grafts
failed. In the fourteen knees in which a portion of the articular opening
of the tibial tunnel was anterior to the slope of the intercondylar roof,
there was moderate impingement on the graft, and four grafts failed (an
unacceptable rate of failure). There was no impingement in the knees in
which the entire articular opening of the tibial tunnel was posterior to
the slope of the intercondylar roof, and these knees were associated with
the lowest rate of failure of the grafts (three of twenty-nine). Knees that
had an impinged graft and regained a complete range of extension became
unstable.
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