Professor Saithna's presentation at ESSKA 2018 on the use of 3D CT Evaluation Of Tunnel Positioning In ACL Reconstruction surgery to demonstrate that preservation of large remnants does not impair precise tunnel placement

1. 3D CT Evaluation Of Tunnel
Positioning In ACL
Reconstruction Using The
Single-Anteromedial Bundle
Biological Augmentation
(SAMBBA) Technique
Professor Adnan Saithna
Nottingham Trent University, UK
Southport & Ormskirk Hospitals, UK
Co-authors:
• Florent Buscayret, France
• Eduardo Frois Temponi, Brazil
• Mathieu Thaunat, France
• Bertrand Sonnery-Cottet, France

2. • Significantly improved clinical and functional outcomes
• Low complications
• Trend towards reduced graft rupture 3.3% (large remnant) vs 7.4%
(small remnant)
• No comparison with standard techniques

3. Potential advantages
Preservation of hamstring attachment and remnant preservation:
Decreased graft rupture rates and better knee stability
Better graft integration
Less bone tunnel widening
Better proprioception
Stem cells, myofibroblasts, mechanoreceptors – greater intrinsic potential for healing

4. Arthroscopy Editorial, March 2018
”The difficulty experienced…in positioning the femoral tunnel...represents 80% of ACL
reconstruction failures”
“The preservation of tissues in the notch may generate difficulties for the surgeon…. in
assessing anatomic positions of the native ACL”

5. Study Objectives
“Evaluate whether consistent tunnel positioning was achieved in a series of patients
undergoing remnant-preserving ACL reconstructions with the SAMBBA technique”
Sonnery-Cottet B, Freychet B, Murphy CG, Pupim BH,
Thaunat M. Anterior cruciate ligament reconstruction
and preservation: the single-anteromedial bundle
biological augmentation (SAMBBA) technique.
Arthrosc Tech. 2014;3:e689-e693.

6. Surgical technique

8. Inclusion criteria
• All patients undergoing primary ACLR by FB during study period were
included except: multiligament injuries, previous knee surgery, remnant
<50%

9. 3D-CT Evaluation

10. Results: n=227 ACLR during study period
99 patients eligible with > 50% remnant
Mean time from injury 5.8 months +/- 4.4 months

11. Altman Classification Cohen Kappa 0.8-1 “Very good”

13. Conclusions
Despite the presence of a large remnant, placement of femoral and tibial
tunnels for anatomic ACL reconstruction using the SAMBBA technique is
consistent and precise.
Large remnants do not compromise tunnel positioning

14. Thank you….