Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation

2015 ◽  
Vol 25 (5) ◽  
pp. 1591-1597 ◽  
Author(s):  
Osmar Valadao Lopes ◽  
Leandro de Freitas Spinelli ◽  
Luiz Henrique Cunha Leite ◽  
Bruce Quatrin Buzzeto ◽  
Paulo Renato Fernades Saggin ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Enlargement ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Femoral Tunnel Enlargement

Influence of the Femoral Tunnel Location and Angle on the Contact Pressure in the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction

2003 ◽  
Vol 31 (3) ◽  
pp. 444-448 ◽  
Author(s):  
Hiroyuki Segawa ◽  
Yoshio Koga ◽  
Go Omori ◽  
Makoto Sakamoto ◽  
Toshiaki Hara
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Contact Pressure ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Enlargement ◽  
Anterior Portion ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background The causes of bone tunnel enlargement after anterior cruciate ligament reconstruction have not been thoroughly investigated. Hypothesis A malpositioned femoral tunnel and an acute femoral tunnel angle may increase the mechanical stress in the femoral tunnel. Study Design Controlled laboratory study. Methods Three femoral tunnels (normal, anterior, and acute) and the tibial tunnel were made in four fresh-frozen cadaveric knees. Aluminum cylinders containing pressure-sensitive conductive rubber sensors at the joint entrance were inserted into the femoral tunnels. Dynamic changes in the contact pressure of the graft in the femoral tunnel were measured. Results Peak contact pressures and dynamic changes in contact pressure for the normal and anterior femoral tunnels demonstrated no differences. Maximum contact pressure of the graft was observed at the anterior portion with the knee in full extension and at the posterior portion with deep knee flexion. Consistent contact pressure occurred at the anterior aspect of the acute femoral tunnel throughout the range of motion. Mean contact pressure at the anterior region of the acute femoral tunnel was significantly higher than that of the normal femoral tunnel at 60°, 90°, and 120° of knee flexion. Conclusions The consistent contact pressure in the anterior aspect of the acute femoral tunnel may erode the anterior portion of the femoral tunnel, resulting in bone tunnel enlargement. Clinical Relevance The femoral tunnel direction in anterior cruciate ligament reconstruction is an important factor in reducing femoral tunnel enlargement.

Tunnel Widening after Anterior Cruciate Ligament Reconstruction

2009 ◽  
Vol 37 (8) ◽  
pp. 1609-1617 ◽  
Author(s):  
Alexandra Neddermann ◽  
Elmar Willbold ◽  
Frank Witte ◽  
Christof Hurschler ◽  
Stefan Hankemeier ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Volume ◽  
Tunnel Widening ◽  
Tunnel Enlargement ◽  
Cruciate Ligament Reconstruction ◽  
Anteroposterior Translation ◽  
Anterior Cruciate

Background A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear. Hypothesis Tunnel widening results in an increased anteroposterior translation, and there are specific histologic changes due to osteoclastic bone resorption associated with this phenomenon. Study Design Controlled laboratory study. Methods Thirty sheep (age, 4 months) underwent an anterior cruciate ligament reconstruction using a soft tissue graft. Graft fixation was achieved using the EndoButton and Suture Washer. Six animals each were sacrificed at 0, 3, 6, 12, and 24 weeks after surgery. Each anterior cruciate ligament–reconstructed knee was examined by computed tomography. Anteroposterior translation was determined using a universal force-moment sensor robot. The bone surrounding the tunnel was evaluated histologically. Results The prevalence of tunnel enlargement on the femoral side was 77.3%. Animals with tunnel widening did not demonstrate increased anteroposterior translation. Widening of the femoral tunnel was significantly associated with a higher stiffness of the graft (P <. 05) and hypertrophy of the graft throughout the remodeling process. The histologic evaluation of the bone tunnel walls demonstrated an increase of bone volume in animals with tunnel enlargement. No statistically significant correlation could be found between the number of osteoclasts and the presence of tunnel widening. Conclusion In this large animal model of anterior cruciate ligament reconstruction, animals with significant tunnel widening did not suffer increased anteroposterior translation. Tunnel widening was associated with a high stiffness of the graft, graft hypertrophy, and an increase in bone volume of the tunnel wall. Clinical Relevance The present data correspond to the current opinion in humans that tunnel widening is not associated with knee instability. Further research is needed to understand the role of graft stiffness, graft hypertrophy, and the increase in bone volume in this phenomenon.

Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft: Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique

2003 ◽  
Vol 31 (2) ◽  
pp. 282-288 ◽  
Author(s):  
Hironori Otsuka ◽  
Yasuyuki Ishibashi ◽  
Eiichi Tsuda ◽  
Kazuhiro Sasaki ◽  
Satoshi Toh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Enlargement ◽  
Cruciate Ligament Reconstruction ◽  
Fixation Group ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Background: Anatomic fixation of the graft in anterior cruciate ligament reconstruction has improved stability of the reconstructed knee joint in experimental studies. Hypothesis: Anatomic fixation of the bone-patellar tendon-bone autograft will reduce tunnel enlargement and improve clinical results. Study Design: Prospective cohort study. Methods: Sixty patients were randomly divided into three groups: a nonanatomic fixation group (traditional single-incision reconstruction), an anatomic fixation group (reconstruction in which a bone plug was grafted into the tibial tunnel), and an anatomic fixation group with all-inside reconstruction. Stability of the knee joint was examined with a KT-1000 arthrometer at 2, 4, 6, 12, and 24 months after surgery. At 12 months, anteroposterior and lateral radiographs were made to assess tunnel enlargement. Results: Although the magnitude of tibial displacement gradually increased after reconstruction in all three groups, the anatomic fixation group had significantly better stability than the groups undergoing nonanatomic fixation or all-inside anatomic fixation at 4 and 6 months after anterior cruciate ligament reconstruction. However, there was no significant difference between the three groups at 24 months. Regarding the tibial tunnel, residual rates and enlargement of tunnels were different between the reconstruction techniques. The nonanatomic reconstruction group had significantly greater tunnel enlargement. Conclusion: Anatomic fixation of the graft decreased the tunnel enlargement but had no effect on knee stability at 2-year follow-up.

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