References / Resources

Improved ACL Reconstruction


Hybrid Transtibial Technique
Pathfinder™ ACL System

Published Clinical and Laboratory Studies

  • Jennings J, Leas D, D’Alessandro D, Peindl R, Piasecki D.Transtibial Versus Anteromedial Portal ACL Reconstruction – Is a Hybrid Approach the Best?Arthroscopy. 2012;28: 1481-1489.
  • Bach BR Jr, Aadalen KJ, Dennis MG, et al.Primary anterior cruciate ligament reconstruction using fresh-frozen, nonirradiated patellar tendon allograft: minimum 2-year follow-up.AmJ SportsMed. 2005;33:284-292.
  • Bach BR Jr, Levy ME, Bojchuk J, Tradonsky S, Bush-Joseph CA, Khan NH.Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation. Am J Sports Med. 1998;26:30-40.
  • Barnes CL, Blaha JD, DeBoer D, Stemniski P, Obert R, Carroll M.Assessment of a medial pivot total knee arthroplasty design in a cadaveric knee extension test model. J Arthroplasty. 2012;27:1460-1468.e14.
  • Bedi A, Maak T, Musahl V, et al.Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important? Am J Sports Med. 2011;39:366-373.
  • Bedi A, Musahl V, Steuber V, et al. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy. 2011;27:380-390.
  • Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ 3rd. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy. 2010;26:342-350.
  • Bhatia S, Korth K, Van Thiel GS, et al. Effect of tibial tunnel diameter on femoral tunnel placement in transtibial single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24:51-57.
  • Brophy RH, Voos JE, Shannon FJ, et al. Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament. Am J Sports Med. 2008;36:2196-2203.
  • Chalmers PN, Mall NA, Cole BJ, Verma NN, Bush-Joseph CA, Bach BR Jr. Anteromedial versus transtibial tunnel drilling in anterior cruciate ligament reconstructions: a systematic review. Arthroscopy. 2013;29:1235-1242.
  • Driscoll MD, Isabell GP Jr, Conditt MA, et al. Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy. 2012;28:1481-1489.
  • Duffee A, Magnussen RA, Pedroza AD, Flanigan DC, Group M, Kaeding CC. Transtibial ACL femoral tunnel preparation increases odds of repeat ipsilateral knee surgery. J Bone Joint Surg Am. 2013;95:2035-2042.
  • Ebersole GM, Eckerle P, Farrow LD, Cutuk A, Bledsoe G, Kaar S.Anterior cruciate ligament graft isometry is affected by the orientation of the femoral tunnel. J Knee Surg. 2016;29:260-266.
  • Fujimaki Y, Thorhauer E, Sasaki Y, Smolinski P, Tashman S, Fu FH.Quantitative in situ analysis of the anterior cruciate ligament: length, midsubstance cross-sectional area, and insertion site areas. Am J Sports Med. 2016;44:118-125.
  • Gadikota HR, Sim JA, Hosseini A, Gill TJ, Li G. The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am J Sports Med. 2012;40:882-888.
  • Goodwillie AD, Shah SS, McHugh MP, Nicholas SJ. The effect of postoperative KT-1000 arthrometer score on long-term outcome after anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45:1522-1528.
  • Heming JF, Rand J, Steiner ME. Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med. 2007;35:1708-1715.
  • Hensler D, Working ZM, Illingworth KD, Thorhauer ED, Tashman S, Fu FH. Medial portal drilling: effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2011;93:2063-2071.
  • Herbort M, Domnick C, Raschke MJ, et al. Comparison of knee kinematics after single-bundle anterior cruciate ligament reconstruction via the medial portal technique with a central femoral tunnel and an eccentric femoral tunnel and after anatomic double-bundle reconstruction: a human cadaveric study. Am J Sports Med. 2016;44:126-132.
  • Kondo E, Merican AM, Yasuda K, Amis AA. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med. 2011;39:279-288.
  • Lee JK, Lee S, Seong SC, Lee MC. Anatomy of the anterior cruciate ligament insertion sites: comparison of plain radiography and three dimensional computed tomographic imaging to anatomic dissection. Knee Surg Sports Traumatol Arthrosc. 2015;23:2297-2305.
  • Lee JS, Kim TH, Kang SY, et al. How isometric are the anatomic femoral tunnel and the anterior tibial tunnel for anterior cruciate ligament reconstruction? Arthroscopy. 2012;28:1504-1512, 1512e1-2.
  • Lubowitz JH. Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique.Knee Surg Sports Traumatol Arthrosc. 2014;22:1190-1195.
  • Morgan CD, Kalmam VR, Grawl DM. Isometry testing for anterior cruciate ligament reconstruction revisited. Arthroscopy. 1995;11:647-659.
  • Morgan CD, Kalman VR, Grawl DM. Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy. 1995;11:275-288.
  • Musahl V, Plakseychuk A, VanScyoc A, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med. 2005;33:712-718.
  • Nawabi DH, Tucker S, Schafer KA, et al. ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med. 2016;44:2563-2571.
  • Noh JH, Roh YH, Yang BG, Yi SR, Lee SY. Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: transtibial technique versus anteromedial portal technique. Arthroscopy. 2013;29:882-890.
  • Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am. 1984;66:344-352.
  • Ode GE, Piasecki DP, Habet NA, Peindl RD. Cortical button fixation: a better patellar tendon repair? Am J Sports Med. 2016;44:2622-2628.
  • Pearle AD, Shannon FJ, Granchi C, Wickiewicz TL, Warren RF. Comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation.Am J Sports Med. 2008;36:1534-1541.
  • Piasecki DP, Bach BR Jr, Espinoza Orias AA, Verma NN. Anterior cruciate ligament reconstruction: can anatomic femoral placement be achieved with a transtibial technique? Am J Sports Med. 2011;39:1306-1315.
  • Plaweski S, Petek D, Saragaglia D. Morphometric analysis and functional correlation of tibial and femoral footprints in anatomical and single bundle reconstructions of the anterior cruciate ligament of the knee. Orthop Traumatol Surg Res. 2011;97(suppl 6):S75-S79.
  • Robinson J, Stanford FC, Kendoff D, Stuber V, Pearle AD. Replication of the range of native anterior cruciate ligament fiber length change behavior achieved by different grafts: measurement using computerassisted navigation. Am J Sports Med. 2009;37:1406-1411.
  • Sadoghi P, Kropfl A, Jansson V, Muller PE, Pietschmann MF, Fischmeister MF. Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27:355-364.
  • Smith JO, Yasen S, Risebury MJ, Wilson AJ. Femoral and tibial tunnel positioning on graft isometry in anterior cruciate ligament reconstruction: a cadaveric study. J Orthop Surg (Hong Kong). 2014;22:318-324.
  • Steiner ME, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M.Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med. 2009;37:1912-1919.
  • Tampere T, Van Hoof T, Cromheecke M, et al. The anterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology. Knee Surg Sports Traumatol Arthrosc. 2017;25:236-244.

Unpublished Reports (available from DanaMed, Inc.)

  • Piasecki D, D’Alessandro D, Connor P and Fleischli J. A Hybrid Transtibial Technique Outperforms both Transtibial and AM Portal Approaches: A Randomized Controlled Blinded Trial. Submitted AAOS, June 2018.
  • Weber A: Hybrid Transtibial Technique Compared to AM Portal and Modified Transtibial Techniques. Data presented at ISAKOS 2017.

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