A CT based evaluation of femoral and tibial tunnel widening after double bundle ACL reconstruction

2020 ◽  
Vol 7 (4) ◽  
pp. 206-210
Author(s):  
Shekhar Tank ◽  
Saurabh Dutt ◽  
Rakesh Sehrawat ◽  
Dhananjaya Sabat ◽  
Vinod Kumar
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Double Bundle Acl Reconstruction

scholarly journals Influence of Graft Bending Angle on Femoral Tunnel Widening After Double-Bundle ACL Reconstruction: Comparison of Transportal and Outside-In Techniques

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110357
Author(s):  
Do Kyung Lee ◽  
Jun Ho Kim ◽  
Byung Hoon Lee ◽  
Hyeonsoo Kim ◽  
Min Jae Jang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Pearson Correlation ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Bending Angle ◽  
Graft Bending Angle ◽  
Significant Difference ◽  
Double Bundle Acl Reconstruction

Background: Previous studies have suggested that increased mechanical stress due to acute graft bending angle (GBA) is associated with tunnel widening and graft failure after anterior cruciate ligament (ACL) reconstruction. Few studies have compared the GBA between the outside-in (OI) and the transportal (TP) techniques. Purpose: To evaluate the influence of GBA on clinical outcomes and tunnel widening after ACL reconstruction with OI versus TP technique. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were 56 patients who underwent double-bundle ACL reconstruction (n = 28 in the OI group and n = 28 in the TP group). Clinical outcomes (Lysholm, International Knee Documentation Committee, Tegner score, and knee laxity) 1 year postoperatively were evaluated. Computed tomography scans at 5 days and 1 year postoperatively were used for imaging measurements, and the femoral tunnel was divided into the proximal third, middle, and aperture sections. The GBA and cross-sectional area (CSA) were measured using image analysis software and were compared between groups. A correlation analysis was performed to determine if the GBA affected clinical outcomes or tunnel widening. Results: No significant difference was observed in clinical outcomes between the groups. The GBA of both the anteromedial (AM) and posterolateral bundles were more acute in the OI group compared with the TP group ( P < .05). The CSA at the AM tunnel aperture increased significantly in the OI group (84.2% ± 64.3%) compared with the TP group (51.4% ± 36.7%) ( P = .04). However, there were no differences in the other sections. In the Pearson correlation test, GBA was not correlated with tunnel widening or clinical outcomes. Conclusion: Regardless of technique, the GBA did not have a significant influence on tunnel widening or clinical outcomes. Considering a wider AM tunnel aperture, a more proximal and posterior AM tunnel position might be appropriate with the OI technique.

The relationship between graft intensity on MRI and tibial tunnel placement in anatomical double-bundle ACL reconstruction

2019 ◽  
Vol 29 (8) ◽  
pp. 1749-1758 ◽  
Author(s):  
Takanori Teraoka ◽  
Yusuke Hashimoto ◽  
Shinji Takahashi ◽  
Shinya Yamasaki ◽  
Yohei Nishida ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Tunnel Placement ◽  
Double Bundle Acl Reconstruction ◽  
The Relationship

Clinical and Second-Look Arthroscopic Study Comparing 2 Tibial Landmarks for Tunnel Insertions During Double-Bundle ACL Reconstruction With a Minimum 2-Year Follow-up

2012 ◽  
Vol 40 (11) ◽  
pp. 2479-2486 ◽  
Author(s):  
Takashi Ohsawa ◽  
Masashi Kimura ◽  
Keiichi Hagiwara ◽  
Hiroshi Yorifuji ◽  
Kenji Takagishi
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Test Results ◽  
Knee Stability ◽  
Posterior Tibial ◽  
Second Look ◽  
Anterior Tibial ◽  
Double Bundle Acl Reconstruction

Background: Few studies have reported the clinical results of tibial tunnel placement during double-bundle anterior cruciate ligament (ACL) reconstruction. It is important to recognize arthroscopic tibial landmarks during this procedure. Hypothesis: During arthroscopic double-bundle ACL reconstruction, anterior tibial landmarks such as the intermeniscal (transverse) ligament and the Parsons knob for the anteromedial (AM) tunnel provide better knee stability and clinical outcomes than do posterior tibial landmarks such as the fovea anterior to the tibial intertubercle ridge for the posterolateral (PL) tunnel. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 121 patients underwent primary unilateral double-bundle ACL reconstructions using autogenous medial hamstring tendons. Fifty-nine patients from December 2008 through July 2009 underwent reconstructions using posterior tibial landmarks (PL group), and 62 patients from August 2009 through February 2010 underwent reconstructions using anterior tibial landmarks (AM group). Forty-seven patients (follow-up rate, 79.7%) in the PL group and 52 patients (follow-up rate, 83.9%) in the AM group underwent second-look arthroscopy and clinical evaluations under anesthesia at 1 year postoperatively and 3-dimensional computed tomography (3-D CT) evaluations at 3 weeks postoperatively. Results: Lachman test results indicated no significant differences, and pivot-shift test results were significantly lower in the AM group ( P = .007). Mean side-to-side differences using the Telos device at 130 N were significantly lower in the AM group (1.4 ± 1.6 mm) compared with the PL group (2.4 ± 2.5 mm) ( P = .012). Results for lack of extension were not significantly different, while those for lack of flexion were significantly better in the AM group than in the PL group ( P = .036). No significant differences were observed in the Lysholm scores between the groups. In measurements of the tibial tunnel position by 3-D CT, with regard to anteroposterior depth, the AM bundle of the PL group was 41.6% ± 7.4% and the AM group was 29.1% ± 5.3% ( P < .001), and the PL bundle of the PL group was 55.6% ± 7.7% and the AM group was 46.4% ± 5.8% ( P < .001). No significant differences were found in mediolateral width. In second-look arthroscopy, there were significant differences with respect to the synovial cover with regard to the AM bundle ( P = .024). Conclusion: Patients in the AM group showed better knee stability and range of motion than those in the PL group. Transverse ligaments and Parsons knobs proved to be useful landmarks during ACL reconstruction.

Analysis of tunnel widening after double-bundle ACL reconstruction

2012 ◽  
Vol 20 (11) ◽  
pp. 2243-2250 ◽  
Author(s):  
Yong Seuk Lee ◽  
Sheen-Woo Lee ◽  
Shin Woo Nam ◽  
Won Seok Oh ◽  
Jae Ang Sim ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Double Bundle Acl Reconstruction

scholarly journals Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Andrea D'Amelio ◽  
Pietro Pellegrino ◽  
Federica Rosso ◽  
Roberto Rossi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterolateral Ligament ◽  
Rotational Instability ◽  
Small Subset ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

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