{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:18:40Z","timestamp":1791584320220,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The goal of the present study was to evaluate a potential tunnel convergence in combined anterior cruciate ligament (ACL) reconstruction using the anteromedial portal technique and lateral extra\u2010articular tenodesis (LET).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ten fresh frozen femora were dissected and a K\u2010wires were inserted into the middle of the ACL stump, according to an ACL reconstruction at 110\u00b0 and 140\u00b0 knee flexion. ACL reconstruction at 120\u00b0 and 130\u00b0 was simulated. Seven K\u2010wires with different femoral insertion sites and angulations were drilled into the lateral femoral condyle relative to the lateral epicondyle (E3: 8 mm proximal and 4 mm posterior; E1: 5 mm proximal and 5 mm anterior and E2: over\u2010the\u2010top position). Tunnel conflict rate was evaluated using a measuring arm and a metrology software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Drilling the femoral ACL tunnel in low knee flexion (110\u00b0\u2010120\u00b0) significantly (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) reduced the tunnel conflict rate compared to the ACL drilled in high knee flexion (130\u00b0\u2010140\u00b0). Changing the insertion point from proximal and posterior (E3) to proximal and anterior (E1) showed a reduced tunnel conflict rate from 40 \u00b1 21.2% to 15 \u00b1 26% and no tunnel conflict for an ACL drilled at 110\u00b0\u2010130\u00b0 knee flexion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A possible tunnel conflict in simultaneous ACL reconstruction using the AMP technique and LET was dependent on ACL knee flexion angle, LET insertion site, and angulation. This posed the dilemma that no generally applicable LET configuration could be recommended to avoid a tunnel conflict. However, it appears that an insertion point located proximal and anterior to the lateral epicondyle results in less tunnel conflicts than an insertion point located proximal and posterior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>An insertion point located proximal and anterior to the lateral epicondyle with a 30\u00b0 proximal and 30\u00b0 anterior angulation could reliably avoid a tunnel conflict when the ACL was drilled between 110 and 130\u00b0 using a low anteromedial portal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2021.05.028","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T13:01:12Z","timestamp":1622120472000},"page":"860-869","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":20,"title":["Tunnel Convergence Rate in Combined Anteromedial Portal Anterior Cruciate Ligament and Anterolateral Structure Reconstructions Is Influenced by Anterior Cruciate Ligament Knee Flexion Angle, Tunnel Position, and Direction"],"prefix":"10.1002","volume":"38","author":[{"given":"Christoph","family":"Kittl","sequence":"first","affiliation":[{"name":"Department of Trauma Hand and Reconstructive Surgery Westphalian Wilhelms University Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Schwietering","sequence":"additional","affiliation":[{"name":"Department of Trauma Hand and Reconstructive Surgery Westphalian Wilhelms University Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Raschke","sequence":"additional","affiliation":[{"name":"Department of Trauma Hand and Reconstructive Surgery Westphalian Wilhelms University Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Trauma Hand and Reconstructive Surgery Westphalian Wilhelms University Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Glasbrenner","sequence":"additional","affiliation":[{"name":"Department of Trauma Hand and Reconstructive Surgery Westphalian Wilhelms University Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wagner","sequence":"additional","affiliation":[{"name":"Sporthopaedicum Berlin Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirco","family":"Herbort","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Munich Clinic Munich 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