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First published on August 16, 2004, doi:10.1177/0363546503262645
This version was published on October 1, 2004
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The American Journal of Sports Medicine 32:1702-1710 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Gravity Reduces the Tibia When Using a Tibial Guide That Targets the Intercondylar Roof

Stephen M. Howell, MD*,{dagger} and Keith W. Lawhorn, MD{ddagger}

From the {dagger} University of California, Davis, Davis, California, and {ddagger} Malcolm Grow Medical Center, Andrews Air Force Base, Maryland

* Address correspondence to Stephen M. Howell, MD, 8100 Timber-lake Way, Suite F, Sacramento, CA 95823 (e-mail: sebhowell{at}mac.com).

Background: Reduction of the tibia relative to the femur with the knee in maximum extension is required to correctly position the tibial tunnel in the sagittal plane when using a guide that targets the intercondylar roof. The authors found no studies that determined (1) whether gravity reduces the tibia and (2) whether roof impingement is prevented without a roofplasty and without positioning the tibial tunnel too posteriorly.

Methods: The position of the tibia relative to the femur was measured from a lateral radiograph of the treated knee in maximum extension with and without the tibial guide and of the contralateral normal knee in extension in single-leg stance (control).

Results: The position of the tibia with and without the tibial guide was not different (P = .33, not significant) and was only 0.7 mm more posterior than the control knee (P = .0075). A roofplasty was not required, and the clearance was 2 mm or less.

Conclusion: Gravity reduces the tibia on the femur when using a guide that targets the intercondylar roof. The use of a tibial guide that targets the intercondylar roof prevents roof impingement without a roofplasty and without positioning the tibial tunnel too posteriorly.

Key Words: anterior cruciate ligament (ACL) • tibial tunnel






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