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.

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 The serial changes of static anterior tibial subluxation on MRI after double-bundle anterior cruciate ligament reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0049
Author(s):  
Hideaki Fukuda ◽  
Takahiro Ogura ◽  
Kenji Takahashi ◽  
Shigehiro Asai
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Double Bundle ◽  
Medial Compartment ◽  
Injury Group ◽  
Significant Difference ◽  
Anterior Tibial ◽  
Text Figure ◽  
Double Bundle Acl Reconstruction

Objectives: Static anterior tibial subluxation after an anterior cruciate ligament (ACL) injury highlights the abnormal relationship between the tibia and femur in patients with ACL insufficiency. One of the aims of ACL reconstruction is to restore the normal tibiofemoral relationship. However, several studies indicated that an abnormal tibiofemoral relationship remained after single-bundle (SB) ACL reconstruction. The purpose of this study was to determine the serial changes of static relationship between tibia and femur in patient who had double-bundle ACL reconstruction with acute and chronic injuries. Methods: Thirty five patients who underwent double-bundle ACL reconstruction between January 1 to July 31, 2017 were included in this prospective study and divided two groups: the acute ACL injury group and the chronic ACL injury group (more than 6 month after injury). All participants underwent preoperative and postoperative magnetic resonance imaging (MRI) at 3 weeks, 3, 6 and 12 months. Anterior tibial subluxation (ATS) of the medial and lateral compartments relative to the femoral condyles were measured on MRI. Results: There were no significant differences in the age and KT side to side difference between both groups (Table 1). The ATS measurements are shown in table 2. In lateral compartment, the ATS in the acute ACL injury group was 5.3mm before surgery, while it was -0.31mm, 3.4mm, 3.5mm and 4.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 6.7mm before surgery, while it was 0.47mm, 3.9mm, 4.6mm and 5.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups. In medial compartment, the ATS in the acute ACL injury group was 1.8mm before surgery, while it was -1.6mm, 0.28mm, 0.93mm and 2.1mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 2.5mm before surgery, while it was -1.4mm, 1.6mm, 1.7mm and 3.0mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups. Conclusion: In both of lateral and medial compartment, the ATS was not significant different between acute and chronic ACL injuries before surgery. In lateral compartment, at 3 weeks, 3months and 6months after surgery, ATS was significantly less than before surgery in both groups. At 12 months, ATS was not significant different from before surgery in both groups. In medial compartment, at 3 weeks, ATS were significantly less than before surgery in both groups. After 3 months, ATS was not significant different from before surgery in both groups. The ATS was not significant different between acute and chronic ACL injuries in the same period after surgery. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results

2017 ◽  
Vol 45 (11) ◽  
pp. 2578-2585 ◽  
Author(s):  
Sally Järvelä ◽  
Tommi Kiekara ◽  
Piia Suomalainen ◽  
Timo Järvelä
Keyword(s):  
Acl Reconstruction ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Significant Group ◽  
Kt 1000 ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Background: A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before. Hypothesis: Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees. Results: Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery ( P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction ( P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction ( P = .024). Conclusion: Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.

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

scholarly journals Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711668552 ◽  
Author(s):  
Tommi Kiekara ◽  
Antti Paakkala ◽  
Piia Suomalainen ◽  
Heini Huhtala ◽  
Timo Järvelä
Keyword(s):  
Clinical Evaluation ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Case Series ◽  
Knee Laxity ◽  
Double Bundle ◽  
Tunnel Enlargement ◽  
Patient Reported ◽  
Double Bundle Acl Reconstruction

Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results.

A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation

2020 ◽  
Author(s):  
Yasunari Ikuta ◽  
Atsuo Nakamae ◽  
Ryo Shimizu ◽  
Masakazu Ishikawa ◽  
Tomoyuki Nakasa ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Double Bundle ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Tibial Rotation ◽  
Knee Stability ◽  
Flexion Extension ◽  
Anterior Tibial ◽  
Tibial Translation

AbstractPostoperative anterior and rotational stability are still controversial when compared with single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventional knee motion, anterior tibial load (100N), and internal-external torque (3 N·m). The anterior tibial translation and total range of tibial rotation were calculated from the measurement values from 20 to 50 degrees at each 5-degree point. The anterior tibial translation (p = 0.59; two-factor repeated measures analysis of variance; η 2G = 0.0077) and total range of tibial rotation (p = 0.95; η 2G = 0.0001) at each knee flexion angle showed no significant difference between the central anatomical SB and anatomical DB reconstruction groups. It is suggested that the central anatomical SB reconstruction is comparable with the anatomical DB reconstruction in biomechanical anteroposterior and rotational knee stability at time 0.

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