The Hybrid Transtibial Technique for Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: A Finite Element Analysis Model of Graft Bending Angles and Peak Graft Stresses in Comparison With Transtibial and Anteromedial Portal Techniques
Bibliographic record
Abstract
PURPOSE: The purpose of this finite element analysis was to compare femoral tunnel length; anterior cruciate ligament reconstruction graft bending angle; and peak graft stress, contact force, and contact area created by the transtibial, anteromedial portal (AMP), and hybrid transtibial techniques. METHODS: Finite element analysis modeling was used to examine anterior cruciate ligament reconstruction models based on transtibial, AMP, and hybrid transtibial femoral tunnel drilling techniques. An evaluation of femoral tunnel length, graft bending angle, peak graft stress, contact force, and contact area was done in comparison of these techniques. RESULTS: The femoral tunnel created with the hybrid transtibial technique was 45.3 mm, which was 13.3% longer than that achieved with the AMP technique but 15.2% shorter than that with the transtibial technique. The femoral graft bending angle with the hybrid transtibial technique (105°) was less acute than that with the AMP technique (102°), but more acute than that with the transtibial technique (109°). At 11° knee flexion, the hybrid transtibial technique had 22% less femoral contact force, 21% less tibial contact force, 21% less graft tension than the AMP technique. Yet, the hybrid transtibial technique had 41% greater femoral contact force, 39% greater tibial contact force, 33% greater graft tension, and 6% greater graft von Mises stress than the transtibial technique. A similar trend was found for the anterior knee drawer test. At both 6-mm anterior tibial displacement and 11° knee flexion, the hybrid transtibial and AMP techniques had at least 51% more femoral contact area than the transtibial technique. CONCLUSION: This finite element analysis highlights that the hybrid transtibial technique is a true hybrid between the AMP and transtibial techniques for femoral tunnel drilling regarding femoral tunnel length, graft bending angle, and peak graft stress.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".