The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

scholarly journals Does Remnant Preservation Influence Tibial Tunnel Enlargement or Graft-to-Bone Integration After Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Suspensory Fixation? A Computed Tomography and Magnetic Resonance Imaging Evaluation

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879023 ◽  
Author(s):  
Takuya Naraoka ◽  
Yuka Kimura ◽  
Eiichi Tsuda ◽  
Yuji Yamamoto ◽  
Yasuyuki Ishibashi
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Tunnel Enlargement ◽  
Tunnel Position ◽  
Remnant Preservation ◽  
Tibial Tunnel Position ◽  
Bone Integration ◽  
Anterior Cruciate

Background: Remnant-preserving anterior cruciate ligament (ACL) reconstruction was introduced to improve clinical outcomes and biological healing. However, the influences of remnant preservation on tibial tunnel position and enlargement are still uncertain. Purpose: To evaluate whether remnant-preserving ACL reconstruction influences tibial tunnel position or enlargement and to examine the relationship between tunnel enlargement and graft-to-bone integration in the tibial tunnel. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 91 knees with double-bundle ACL reconstructions were enrolled in this study. ACL reconstruction was performed without a remnant (<25% of the intra-articular portion of the graft) in 44 knees (nonremnant [NR] group) and with remnant preservation in the remaining 47 knees (remnant-preserving [RP] group). Tibial tunnel position and enlargement were assessed using computed tomography (CT). Comparisons between groups were performed. Furthermore, graft-to-bone integration in the tibial tunnel was evaluated using magnetic resonance imaging, and the relationship between tunnel enlargement and graft-to-bone integration at 1 year after ACL reconstruction was assessed. Results: A total of 48 knees (25 in NR group, 23 in RP group) were included; 19 and 24 knees in the NR and RP groups were excluded, respectively, because of graft reruptures and a lack of CT scans. There were no significant between-group differences in tibial tunnel position ( P > .05). The degree of posterolateral tunnel enlargement in the axial plane was significantly higher in the RP group than that in the NR group ( P = .007) 1 year after ACL reconstruction. The degree of anteromedial tunnel enlargement on axial CT was significantly smaller in knees with graft-to-bone integration than in those without integration ( P = .002) 1 year after ACL reconstruction. Conclusion: ACL reconstruction with remnant preservation did not influence tibial tunnel position and did not decrease the degree or incidence of tibial tunnel enlargement. At 1 year postoperatively, tunnel enlargement did not affect graft-to-bone integration in the posterolateral tunnel, but graft-to-bone integration was delayed in the anteromedial tunnel.

Evaluation of Tibial Tunnel Location with the Femoral Tunnel Created Behind the Resident's Ridge in Transtibial Anterior Cruciate Ligament Reconstruction

2021 ◽  
Author(s):  
Tsuneari Takahashi ◽  
Tomohiro Saito ◽  
Tatsuya Kubo ◽  
Ko Hirata ◽  
Hideaki Sawamura ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Anterior Cruciate ◽  
Tunnel Positions ◽  
Tunnel Angle ◽  
Coronal View

AbstractFew studies have determined whether a femoral bone tunnel could be created behind the resident's ridge by using a transtibial (TT) technique-single bundle (SB)-anterior cruciate ligament (ACL) reconstruction. The aim of this study was to clarify (1) whether it is possible to create a femoral bone tunnel behind the resident's ridge by using the TT technique with SB ACL reconstruction, (2) to define the mean tibial and femoral tunnel angles during anatomic SB ACL reconstruction, and (3) to clarify the tibial tunnel inlet location when the femoral tunnel is created behind resident's ridge. Arthroscopic TT-SB ACL reconstruction was performed on 36 patients with ACL injuries. The point where 2.4-mm guide pin was inserted was confirmed, via anteromedial portal, to consider a location behind the resident's ridge. Then, an 8-mm diameter femoral tunnel with a 4.5-mm socket was created. Tunnel positions were evaluated by using three-dimensional computed tomography (3D-CT) 1 week postoperatively. Quadrant method and the resident's ridge on 3D-CT were evaluated to determine whether femoral tunnel position was anatomical. Radiological evaluations of tunnel positions yielded mean ( ±  standard deviation) X- and Y-axis values for the tunnel centers: femoral tunnel, 25.2% ± 5.1% and 41.6% ± 10.2%; tibial tunnel, 49.2% ± 3.5%, and 31.5% ± 7.7%. The bone tunnels were anatomically positioned in all cases. The femoral tunnel angle relative to femoral axis was 29.4 ± 5.5 degrees in the coronal view and 43.5 ± 8.0 degrees in the sagittal view. The tibial tunnel angle relative to tibial axis was 25.5 ± 5.3 degrees in the coronal view and 52.3 ± 4.6 degrees in the sagittal view. The created tibial bone tunnel inlet had an average distance of 13.4 ± 2.7 mm from the medial tibial joint line and 9.7 ± 1.7 mm medial from the axis of the tibia. Femoral bone tunnel could be created behind the resident's ridge with TT-SB ACL reconstruction. The tibial bone tunnel inlet averaged 13.4 mm from the medial tibial joint line and 9.7 mm medial from the tibia axis.

scholarly journals Effect of Thrombocyte-rich Plasma on Prevention of Tunnel Enlargement in Anterior Cruciate Ligament (ACL) Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0005
Author(s):  
Serkan Sözkesen ◽  
Hüseyin Gökhan Karahan ◽  
Serhan Yağdı ◽  
Ahmet Kurtulmuş ◽  
Cemil Kayalı ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Treatment Protocol ◽  
Control Group ◽  
Imaging Method ◽  
Slice Thickness ◽  
Tunnel Enlargement ◽  
Minimum Age

This study was conducted to 44 patients, to whom both hamstring tendon autograft and transtibial ACL reconstruction were applied, having treatment in Clinic of Orthopedics and Traumatology in İzmir Bozyaka Training and Research Hospital between dates of March 2014 and July 2015. Treatment group (18 patients, subjected to PRP) and control group (26 patients) selected with random method were taken. Minimum age in the treatment group was 16 and maximum age was 38, having an average of (26±6,96). Minimum age in the treatment group was 14 and maximum age was 43, having an average of (26,54±7,93). In this group, 27 patients have had operation on right knee (61%), 17 patients on left knee (39%). Follow up period after surgery is at least 4 months, at most 16 months, with an average period of 12 months. Injury reason of ACL was sport injury for 36 patients, injury of falling down from height for 1 patient and injury of occupational accident for 6 patients. Reasons of application of these patients are distrust for 30 patients, pain for 10 patients and locked-in findings for 4 patients. General physical examinations of these patients were performed prior to surgery, and direct graphy and MR imaging method was used for the patients. The patients were evaluated with IKDC score, Lysholm score, Tegner activity scale, KT-1000 arthrometer device and multi-slice tomography in preoperative and postoperative methods. The same physical treatment protocol was applied for all patients. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial plans after 64-slice MSCT scanning. BT slice thickness was calculated as 1 mm using automatic software with 0.75 mm retrorecons. Measurements were evaluated by the same radiology expert. On comparison of radiological data between both groups, although tunnel enlargement is less in PRP-administered group for femoral tunnel, the result was not significant statistically. No difference was seen between clinical examination results and used grading scales. It was seen that PRP use was not effective in preventing or decreasing femoral and tibial tunnel enlargement in patients having ACL reconstruction with Hamstring. There was a decrease in tunnel enlargement in case of the use of PRP, however, this decrease was not clinically significant. In line with these data, routine use of PRP is not recommended for the prevention of tunnel enlargement after ACL reconstruction. KeyWords: Thrombocyte-rich plasma (PRP), Tunnel enlargement, ACL reconstruction, BT scan

scholarly journals Outcomes of human umbilical cord blood-derived mesenchymal stem cells in enhancing tendon-graft healing in anterior cruciate ligament reconstruction: an exploratory study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Sang Won Moon ◽  
Sinhyung Park ◽  
Minkyung Oh ◽  
Joon Ho Wang
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Positive Control ◽  
Control Group ◽  
Human Umbilical Cord Blood ◽  
Human Umbilical Cord ◽  
Tunnel Enlargement ◽  
Anterior Cruciate

Abstract Background The study investigated whether allogeneic human umbilical cord blood-derived MSCs (hUCB-MSCs) could be safely used without treatment-related adverse events, reducing tunnel enlargement, and improve clinical results in human anterior cruciate ligament (ACL) reconstruction. Methods Thirty patients were enrolled consecutively. They were divided into three groups by randomization. In the negative control group, ACL reconstruction surgery without additional treatment was performed. In the experimental group, a hUCB-MSC and hyaluronic acid mixture was applied to the tendon-bone interface of the femoral tunnels during ACL reconstruction surgery. In the positive control group, only hyaluronic acid was applied. Finally, 27 patients were analyzed after the exclusion of three patients. The incidence of treatment-related adverse events, clinical outcomes, including second-look arthroscopic findings, and the amount of tunnel enlargement, were evaluated. Results There were no treatment-related adverse events in the treatment groups. Tunnel enlargement in the experimental group (579.74 ± 389.85 mm3) was not significantly different from those in the negative (641.97 ± 455.84 mm3) and positive control (421.96 ± 274.83 mm3) groups (p = 0.6468). There were no significant differences between the groups in clinical outcomes such as KT-2000 measurement (p = 0.793), pivot shift test (p = 0.9245), International Knee Documentation Committee subjective score (p = 0.9195), Tegner activity level (p = 0.9927), and second-look arthroscopic findings (synovial coverage of the graft, p = 0.7984; condition of the graft, p = 0.8402). Conclusions Allogeneic hUCB-MSCs were used safely for ACL reconstruction without treatment-related adverse event in a 2-year follow-up. However, our study did not suggest any evidence to show clinical advantage such as the prevention of tunnel enlargement postoperatively and a decrease in knee laxity or improvement of clinical outcomes. Trial registration CRIS, Registration Number: KCT0000917. Registered on 12 November 2013; https://cris.nih.go.kr/cris/index.jsp

PRP on Preventıon of Tunnel Enlargement in ACL Reconstructıon

2018 ◽  
Vol 20 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Serkan Sözkesen ◽  
Huseyin Gokhan Karahan ◽  
Ahmet Kurtulmus ◽  
Cemil Kayali ◽  
Taskin Altay
Keyword(s):  
Acl Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Control Group ◽  
Tunnel Enlargement ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Kt 1000

Background. The purpose of this study is to describe the role of Platelet Rich Plasma in preventing tunnel enlargement in anterior cruciate ligament reconstruction with a hamstring autograft Material and methods. Forty-four patients who underwent transtibial reconstructive surgery with a hamstring tendon autograft between March 2014 and July 2015 were included in this study. This study involved two groups. Group A consisted of 18 patients who underwent PRPadministration into the femoral and tibial tunnel. Group B was a control group that included 26 patients who underwent ACL reconstruction surgery with a hamstring autograft without PRP. The patients were evaluated preoperatively and postoperatively with the IKDC score, Lysholm score, Tegner activity scale and a KT-1000 arthrometer device. The diameter of the tibial and femoral tunnels of the operated knees was measured on the first day and at three months postoperatively using CT. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial images from 64-slice MSCT scans. Results. On comparison of radiological data between both groups, there was less tunnel enlargement in PRP-administered group for the femoral tunnel, but the result was not statistically significant. No difference was seen between clinical examination results and the grading scales used. Conclusions. 1. The radiological findings of our study indicated that while there was less tunnel enlargement in the PRP group, there was no statistically significant difference between the groups. 2. Similarly, clinical exa­mination results and scoring scales used did not de­monstrate any intergroup difference. 3. As a result, we donot recommend routine use of PRP for the prevention of tunnel enlargement after ACL reconstruction.

scholarly journals Bioresorbable Stent in Anterior Cruciate Ligament Reconstruction

Polymers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1961
Author(s):  
Krzysztof Ficek ◽  
Jolanta Rajca ◽  
Mateusz Stolarz ◽  
Ewa Stodolak-Zych ◽  
Jarosław Wieczorek ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Control Group ◽  
Microstructural Parameters ◽  
Beneficial Effects ◽  
Anterior Cruciate

The exact causes of failure of anterior cruciate ligament (ACL) reconstruction are still unknown. A key to successful ACL reconstruction is the prevention of bone tunnel enlargement (BTE). In this study, a new strategy to improve the outcome of ACL reconstruction was analyzed using a bioresorbable polylactide (PLA) stent as a catalyst for the healing process. The study included 24 sheep with 12 months of age. The animals were randomized to the PLA group (n = 16) and control group (n = 8), subjected to the ACL reconstruction with and without the implantation of the PLA tube, respectively. The sheep were sacrificed 6 or 12 weeks post-procedure, and their knee joints were evaluated by X-ray microcomputed tomography with a 50 μm resolution. While the analysis of tibial and femoral tunnel diameters and volumes demonstrated the presence of BTE in both groups, the enlargement was less evident in the PLA group. Also, the microstructural parameters of the bone adjacent to the tunnels tended to be better in the PLA group. This suggested that the implantation of a bioresorbable PLA tube might facilitate osteointegration of the tendon graft after the ACL reconstruction. The beneficial effects of the stent were likely associated with osteogenic and osteoconductive properties of polylactide.

scholarly journals A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanliang Du ◽  
Haifeng Dai ◽  
Zhihui Wang ◽  
Di Wu ◽  
Changjiang Shi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Giant Cells ◽  
X Rays ◽  
Artificial Ligament ◽  
Late Failure ◽  
Anterior Cruciate ◽  
Lars Artificial Ligament

Abstract Background A ligament advanced reinforcement system (LARS) artificial ligament has been proposed for use in anterior cruciate ligament (ACL) reconstruction, and many reports have shown its success in ACL reconstruction. However, there are great concerns about the potential risk of complications, which might prevent its extensive use. Late failure may occur due to serious complications. Case presentation We report a rare case of serious osteoarthritis that occurred 2 years postoperatively in a 51-year-old man who underwent reconstruction with an LARS artificial ligament. In X-rays, the tibial tunnel was placed too posteriorly. MRI showed that the tibial tunnel was enlarged, and there was a large effusion in the knee joint. The LARS device was rough and worn. Histologically, a large number of fibroblasts and a few multinucleated giant cells infiltrated the graft fibres. Conclusion Our findings remind surgeons that an LARS device should be with great caution in ACL reconstruction.

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.

Effect of Remnant-Preserving Reconstruction of Acute Anterior Cruciate Ligament Injuries in a Rabbit Model: Histological and Biomechanical Analysis

2022 ◽  
Vol 12 (5) ◽  
pp. 897-906
Author(s):  
XiaoChen Ju ◽  
Hao Chai ◽  
Sasirekha Krishnan ◽  
Abinaya Jaisankar ◽  
Murugan Ramalingam ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Cruciate Ligament ◽  
Cartilage Degeneration ◽  
Remnant Preservation ◽  
Model Animal ◽  
Anterior Cruciate ◽  
Articular Cartilage Degeneration

Acute anterior cruciate ligament (ACL) is a key structure that stabilizes knee joints. The objective of this research is to investigate the influence of ligament remnants preserved on the tendon-bone healing following ACL reconstruction and to examine postoperative articular cartilage degeneration in rabbit as a model animal. Sixty New Zealand rabbits are randomly divided into an ACL reconstruction without remnant preservation group (Group A; n = 30) or ACL reconstruction with remnant preservation group (Group B; n = 30). The expression of HIF-1α, VEGF, and micro vessel density (MVD) in the transplanted tendon was detected by immunohistochemical staining at week 6 and 12 after the operation. The signal intensity of the transplanted tendon was observed by MRI scanning, and the width of the bone tunnel was measured by CT scanning at week 6 and 12 after the operation. The graft biomechanics was tested 12 weeks after the operation. The JNK and MMP-13 expression levels were compared to analyze the cartilage degeneration of the knee at week 12 after the operation. The experimental results were analyzed and showed that the remnant-preserving ACL reconstruction is beneficial for bone healing of the tendon in rabbits, but ACL reconstruction with or without ligament remnants preserved will not affect knee articular cartilage degeneration post-surgery.

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