Tibial bone tunnel widening is reduced by polylactate/hydroxyapatite interference screws compared to metal screws after ACL reconstruction with hamstring grafts

The Knee ◽  
2009 ◽  
Vol 16 (6) ◽  
pp. 447-451 ◽  
Author(s):  
Martin Lind ◽  
Julian Feller ◽  
Kate E. Webster
Keyword(s):  
Acl Reconstruction ◽  
Bone Tunnel ◽  
Tunnel Widening ◽  
Interference Screws ◽  
Tibial Bone ◽  
Hamstring Grafts

scholarly journals Bone Tunnel Enlargement after ACL Reconstruction with Hamstring Autograft Is Dependent on Original Bone Tunnel Diameter

2017 ◽  
Vol 03 (02) ◽  
pp. e96-e100 ◽  
Author(s):  
Steffen Sauer ◽  
Martin Lind
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Preoperative Evaluation ◽  
Bone Tunnel ◽  
Tunnel Widening ◽  
Tunnel Enlargement ◽  
Hamstring Autograft ◽  
Bone Tunnel Enlargement ◽  
Tibial Bone ◽  
Tunnel Diameter

Background Bone tunnel enlargement is a well-established phenomenon following anterior cruciate ligament (ACL) reconstruction, and is related to soft tissue grafts, suspension fixation devices, and absorbable implants. Severe tunnel enlargement can lead to reconstruction failure. The correlation between bone tunnel enlargement following ACL reconstruction and original bone tunnel diameter has not been elucidated. Purpose To determine whether bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original tunnel diameter established during primary ACL reconstruction. Materials and Methods A retrospective review was conducted on 56 patients scheduled for ACL revision surgery who had undergone computed tomography (CT) scanning as part of their preoperative evaluation. All patients had undergone previous hamstring ACL reconstruction. Original femoral and tibial bone tunnel diameters were extracted from operative reports, and femoral and tibial bone tunnel enlargement was assessed on CT serial sections. The correlation between original tunnel diameter and bone tunnel enlargement was investigated using regression analysis. Results Mean tibial bone tunnel enlargement was significantly and inversely dependent on the original tibial bone tunnel diameter with a correlation coefficient of −0.55 per unit (7 mm = +1.93 mm, 8 mm = +1.43 mm, 9 mm = 0.83 mm, p = 0.007). Thus, every additional increase (mm) in diameter of the original tibial bone tunnel reduces the extend of tunnel widening by 0.55 mm. Conclusions The results of this study indicate that tibial bone tunnel enlargement following ACL reconstruction is dependent on original tibial bone tunnel diameter with smaller diameter tunnels developing more tunnel enlargement than larger tunnels. The contributing factors remain unclear and need to be further investigated.

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

2019 ◽  
Vol 07 (02) ◽  
pp. 230 ◽  
Author(s):  
A. de Beus ◽  
J.EJ Koch ◽  
A. Hirschmann ◽  
M.T. Hirschmann
Keyword(s):  
Acl Reconstruction ◽  
Critical Review ◽  
Bone Tunnel ◽  
Tunnel Widening

scholarly journals REDUCTION IN HAMSTRING AUTOGRAFT DIAMETER AS A RESULT OF ACL RECONSTRUCTION PREPARATION USING LONGITUDINAL TENSION AND CIRCUMFERENTIAL COMPRESSION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0012
Author(s):  
Calvin Chan ◽  
Kevin Dale ◽  
Ryan J. Koehler ◽  
Theodore J. Ganley ◽  
J. Todd Lawrence
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Intraoperative Complications ◽  
Bone Tunnel ◽  
Joint Fluid ◽  
Rank Test ◽  
Tunnel Widening ◽  
Hamstring Autograft ◽  
Longitudinal Tension ◽  
Double Bundle Acl Reconstruction

Background: Previous studies have investigated the effect of tension and circumferential compression on the diameter of fresh-frozen anterior cruciate ligament (ACL) allografts, but no study has described the effect on soft tissue ACL autografts harvested for implantation in the operating room for ACL reconstruction. The purpose of this study was to elucidate how hamstring autograft diameter changes during preparation for ACL reconstruction with compression in addition to tensioning. We hypothesized that autograft diameter would decrease as the graft was prepared with both tension and circumferential compression. Operative complications related to graft compression were also investigated. Methods: 100 ACL reconstruction surgeries (Age M = 15.3 ± 2.2 years; 53% male) were identified among two orthopedic surgeons. Hamstring tendon grafts were prepared in a standardized procedure to produce a looped graft for all-inside ACL reconstruction. Autografts were tensioned to 15-20 lbs and then their tibial and femoral diameters were measured using cylindrical sizing blocks. The graft diameters were measured again after placement under a saline soaked gauze for 10 minutes with the sizing blocks in place. A Wilcoxon signed rank test with correction for continuity was performed to detect significant change in autograft diameters after compression. Results: Treatment of hamstring autografts with longitudinal tension and circumferential compression significantly decreased the median tibial and femoral graft diameters by 0.75 mm. The median tibial diameter decreased from 9.50 mm to 8.75 mm (p < 0.0001) and the median femoral diameter decreased from 9.50 mm to 8.50 mm (p < 0.0001). 72% of all autografts had the same tibial and femoral diameters at implant. No intraoperative complications were noted with implantation of compressed grafts in smaller diameter tunnels. Conclusions: Median diameters of ACL hamstring autografts harvested in the OR decreased by 0.75 mm after treatment with circumferential compression using cylindrical sizing blocks. This decreased the socket size by one to two 0.5 mm sizes with no adverse events noted intra-operatively due to the compression of the grafts or the smaller sockets. Clinical Relevance: Graft integration in a bone tunnel is dependent on optimal fit of the graft inside the tunnel. If the tunnel is too small, the graft will not fit and if it is too large, it may allow joint fluid into the tunnel leading to tunnel widening and incomplete integration. Pre-tensioning a graft has been noted for many years to be an important way to properly establish the length-tension relationship of a graft. Here, we show that circumferential compression of the graft prior to implantation significantly changes the size of the graft, and thus the size of the tunnels required for implantation. In addition to providing better graft tunnel match, using smaller tunnels requires less bone removal which is particularly advantageous for pediatric, revision, and double bundle ACL reconstruction techniques where space for tunnel drilling is limited.

scholarly journals Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110064
Author(s):  
Brian Scrivens ◽  
Melissa A. Kluczynski ◽  
Marc S. Fineberg ◽  
Leslie J. Bisson
Keyword(s):  
Computed Tomography ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Tibial Tunnel ◽  
Cyst Formation ◽  
Tunnel Widening ◽  
Cross Sectional ◽  
Interference Screws ◽  
Computed Tomography Scans ◽  
Tunnel Size

Background: Bioabsorbable interference screws tend to have high resorption rates after anterior cruciate ligament (ACL) reconstruction; however, no studies have examined screws composed of 30% biphasic calcium phosphate and 70% poly-d-lactide (30% BCP/70% PLDLA). Purpose: To evaluate femoral and tibial tunnel widening and resorption of 30% BCP/70% PLDLA interference screws and replacement with bone at 2 to 5 years after ACL reconstruction using bone–patellar tendon–bone (BTB) autograft. Study Design: Case series; Level of evidence, 4. Methods: Included were 20 patients who had undergone ACL reconstruction using BTB autograft and were reevaluated 2 to 5 years after surgery using computed tomography scans. Tunnel measurements were obtained from computed tomography scans in the sagittal and coronal planes and were compared with known tunnel measurements based on operative reports. These images and measurements were used to assess tunnel widening, resorption of the 30% BCP/70% PLDLA screw, its replacement with bone, and possible cyst formation. Paired t tests were used to compare initial and final femoral and tibial tunnel measurements. Results: The cross-sectional area of the femoral tunnel decreased at the aperture ( P = .03), middle ( P = .0002), and exit ( P < .0001) of the tunnel compared with the initial femoral tunnel size, and the tibial tunnel cross-sectional area decreased at the aperture ( P < .0001) and exit ( P = .01) of the tunnel compared with the initial tibial tunnel size. Bone formation was observed in 100% of femoral tunnels and 94.7% of tibial tunnels. Screw resorption was 100% in the femur and 94.7% in the tibia at the final follow-up. Cysts were noted around the femoral tunnel in 2 patients (5.1%). Conclusion: The 30% BCP/70% PLDLA interference screws used for ACL reconstruction using BTB autograft had high rates of resorption and replacement with bone, and there were no increases in tunnel size at 2 to 5 years postoperatively. The authors observed a low rate of cyst formation and no other adverse events stemming from the use of this specific biointerference screw, suggesting that this type of screw is a reasonable option for graft fixation with minimal unfavorable events and a reliable resorption profile.

Sign in / Sign up

Export Citation Format

Share Document