Clavicular Bone Tunnel Malposition Leads to Early Failures in Coracoclavicular Ligament Reconstructions

2012 ◽  
Vol 41 (1) ◽  
pp. 142-148 ◽  
Author(s):  
Jay B. Cook ◽  
James S. Shaha ◽  
Douglas J. Rowles ◽  
Craig R. Bottoni ◽  
Steven H. Shaha ◽  
...  
Keyword(s):  
Tendon Graft ◽  
Active Duty ◽  
Bone Tunnel ◽  
Tunnel Placement ◽  
Early Failure ◽  
Lateral Border ◽  
Tunnel Position ◽  
Joint Dislocations ◽  
Early Failures ◽  
Bone Tunnels

Background: Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure. Purpose: To evaluate the effect of clavicular tunnel position in CC ligament reconstruction as a risk of early failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of a consecutive series of CC ligament reconstructions performed with 2 clavicular bone tunnels and a free tendon graft. The population was largely a young, active-duty military group of patients. Radiographs were analyzed for the maintenance of reduction and location of clavicular bone tunnels using a picture archiving and communication system. The distance from the lateral border of the clavicle to the center of each bone tunnel was divided by the total clavicular length to establish a ratio. Medical records were reviewed for operative details and functional outcome. Failure was defined as loss of intraoperative reduction. Results: The overall failure rate was 28.6% (8/28) at an average of 7.4 weeks postoperatively. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid (a ratio of 0.292 vs 0.248; P = .012) and trapezoid bone tunnels (a ratio of 0.171 vs 0.128; P = .004); this correlated to an average of 7 to 9 mm more medial in the reconstructions that failed. Reconstructions performed with a conoid ratio of ≥0.30 were significantly more likely to fail (5/5, 100%) than were those performed lateral to a ratio of 0.30 (3/23, 13.0%) ( P < .01). There were no failures when the conoid ratio was <0.25 (0/10, 0%). Conoid tunnel placement was also statistically significant for predicting return to duty in our active-duty population. Conclusion: Medial tunnel placement is a significant factor in risk for early failures when performing anatomic CC ligament reconstructions. Preoperative templating is recommended to evaluate optimal placement of the clavicular bone tunnels. Placement of the conoid tunnel at 25% of the clavicular length from the lateral border of the clavicle is associated with a lower rate of lost reduction and a higher rate of return to military duty.

scholarly journals Cadaveric Testing of a Novel Scapholunate Ligament Reconstruction

2017 ◽  
Vol 07 (02) ◽  
pp. 141-147
Author(s):  
Lana Kang ◽  
Christopher Dy ◽  
Mike Wei ◽  
Krystle Hearns ◽  
Michelle Carlson
Keyword(s):  
Repeated Measures ◽  
Dorsal Surface ◽  
Tendon Graft ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Reconstruction Technique ◽  
Interosseous Ligament ◽  
Lunate Bone ◽  
Radiocarpal Joint ◽  
Bone Tunnels

Background Existing scapholunate interosseous ligament (SLIL) reconstruction techniques include fixation spanning the radiocarpal joint, which do not reduce the volar aspect of the scapholunate interval and may limit wrist motion. Questions/Purpose This study tested the ability of an SLIL reconstruction technique that approximates both the volar and dorsal scapholunate intervals, without spanning the radiocarpal joint, to restore static scapholunate relationships. Materials and Methods Scapholunate interval, scapholunate angle, and radiolunate angle were measured in nine human cadaveric specimens with the SLIL intact, sectioned, and reconstructed. Fluoroscopic images were obtained in six wrist positions. The reconstruction was performed by passing tendon graft through bone tunnels from the dorsal surface toward the volar corner of the interosseous surface. After reduction of the scapholunate articulation, the graft was tensioned within the lunate bone tunnel, secured with an interference screw in the scaphoid, and sutured to the dorsal SLIL remnant. Differences among testing states were evaluated using repeated measures ANOVA. Results There was a significant increase in the scapholunate interval in all wrist positions after complete SLIL disruption. Compared with the disrupted state, there was a significant decrease in scapholunate interval in all wrist positions after reconstruction using a tendon graft and interference screw. Conclusion Our SLIL reconstruction technique reconstructs the volar and dorsal ligaments of the scapholunate joint and adequately restores static measures of scapholunate stability. This technique does not tether the radiocarpal joint and aims to optimize volar reduction. Clinical Relevance Our technique offers an alternative option for SLIL reconstruction that successfully restores static scapholunate relationships.

scholarly journals Quantitative MRI Evaluation of Tunnel placement in ACL Reconstruction

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0018
Author(s):  
David A. Parker ◽  
Samuel Grasso ◽  
Corey Scholes ◽  
Brett Fritsch ◽  
Qing Li
Keyword(s):  
Acl Reconstruction ◽  
Measurement Method ◽  
Bone Tunnel ◽  
Intraoperative Navigation ◽  
Reconstruction Technique ◽  
Tunnel Placement ◽  
Simple Method ◽  
Revision Acl Reconstruction ◽  
Bone Tunnels ◽  
Routine Assessment

Introduction: Positioning of the graft ACL in the native footprint center is important to replicate the anatomy and function of the ACL for each individual patient. It is known that incorrect bone tunnel placement for the reconstructed ligament is a contributor to poor clinical outcomes postoperatively. Currently the success of tunnel placement is determined by training and experience of the treating surgeon and there is no universally accepted quantifiable and objective method to evaluate the execution of these decisions. The goal of this project was to develop a quantitative routine assessment to assist pre-surgical planning and also evaluate the execution of femoral and tibial bone tunnel placement in ACL reconstructed knees. Methods: The study recruited failed primary ACL reconstructed patients (N=25) who consented to undergo revision ACL reconstruction to establish the placement of the graft ACL tunnel apertures in the femur and tibia. Prior to surgery each participant underwent high resolution 3 T MRI of their injured knee and 3D models were generated through segmentation of soft and hard tissue knee structures. During surgery previous graft tunnels and prominent reference landmarks visible on MRI and arthroscopically were registered using intraoperative navigation to act as the reference standard. The placement of the tunnel apertures in the femur and tibia were measured in all three planes using a novel measurement method. Results: Preliminary result show that the measurement method can assess the placement of tunnel apertures in the femur and tibia within 0.1 – 1.0 mm of the intraoperative data, using reference landmarks identifiable in MRI and arthroscopically. Additionally, the area of the tunnel aperture, bone tunnel volume can be evaluated. Reliability and validation of the novel method is ongoing using medical imaging and intraoperative navigation to register the placement of bone tunnels in revision ACL reconstruction patients. Conclusions: Correct placement of graft ACL bone tunnels inside the native ACL footprint is critical to the outcome of ACL reconstruction. Development of an accurate reproducible method for assessment of tunnel placement relative to the anatomical footprint should provide a simple method for objectively assessing ACL reconstructions. Preliminary results of this routine assessment suggests that graft tunnel placement can be objectively assessed to assist clinicians to evaluate and improve ACL reconstruction technique and evaluation of ACL reconstruction outcomes.

Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 46 (7) ◽  
pp. 1624-1631 ◽  
Author(s):  
Samuel Grasso ◽  
James Linklater ◽  
Qing Li ◽  
David A. Parker
Keyword(s):  
Quantitative Assessment ◽  
Cruciate Ligament ◽  
Proton Density ◽  
3D Ct ◽  
Tunnel Placement ◽  
Tunnel Position ◽  
Reference Models ◽  
Mri Protocol ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: No standardized methodology and objective criteria currently exist to accurately and objectively assess tunnel placement and consequent graft orientation in anterior cruciate ligament (ACL) reconstruction (ACLR) through a single imaging modality. Advances in magnetic resonance imaging (MRI) technology have enabled the use of volumetric high spatial and contrast resolution proton density–weighted sequencing, which allows precise delineation of graft orientation, tunnel position, and quantitative assessment of tunnel position relationship to adjacent reproducible anatomic landmarks. Purpose: To establish an MRI protocol that would provide an accurate alternative to 3-dimensional computed tomography (3D-CT) for standardized assessment of bone tunnel placement in ACLR, as a component of assessing ACLR outcomes and to assist in presurgical planning for revision ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty-four participants diagnosed with a failed ACLR underwent MRI and 3D-CT per the imaging protocols of the Sydney Orthopaedic Research Institute, in which the acquired data were converted to 3D models. The bone tunnels of the previous ACLR were then intraoperatively digitized at the tunnel aperture and along the length of the tunnel (barrel) and used as the reference standard to evaluate the accuracy of high-resolution MRI and 3D-CT. Differences in geometry between the image-based model and the reference point cloud were calculated through point-to-point comparison. Results: At the tunnel apertures, no significant differences were detected between the MRI and 3D-CT models versus the reference models for the femur ( P = .9472) and tibia ( P = .5779). Mean ± SD tunnel barrel deviations between MRI and 3D-CT were 0.48 ± 0.28 mm (femur) and 0.46 ± 0.27 mm (tibia). No significant differences were detected between the MRI and 3D-CT models versus the reference models for the femoral ( P = .5730) and tibial ( P = .3002) tunnel barrels. Conclusion: This study demonstrated that, in addition to being the optimum modality for assessment of soft tissue injury of the knee, a high-resolution 3D turbo spin echo proton density sequence can provide an accurate assessment of tunnel placement, without the use of ionizing radiation. Therefore, this protocol provides the foundation for an objective standardized platform to quantitatively evaluate the location of ACL bone tunnels and graft orientation for routine postoperative assessment, presurgical planning, and evaluation of clinical outcomes.

scholarly journals 384 Use of A Dry Swab During ACL Hamstring Tendon Graft Preparation May Lead to Decreased Graft Diameter at Implantation with Subsequent Rebound in Graft Diameter When Exposed to Haemarthrosis – A Porcine Tendon Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
N Jain
Keyword(s):  
Hamstring Tendon ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Preparation Technique ◽  
Hamstring Tendon Graft ◽  
Press Fit ◽  
The Press ◽  
Bone Tunnels ◽  
Graft Diameter ◽  
Selection Of

Abstract Introduction ACL reconstruction surgery commonly utilises a hamstring tendon graft. Grafts are normally covered with a wet swab prior to implantation. The aim of this study was to determine the variance in graft diameter when comparing the traditional wet swab to a dry swab. Method Flexor tendons from a selection of fresh pig trotters were isolated and prepared with a standard ACL graft preparation technique. Half of the grafts were covered with a wet swab; the other half were covered with a dry swab. Graft diameters were measured at 10-minute intervals. After 30 minutes the grafts were submerged in Hartmann’s solution to simulate the post-operative haemarthrosis, diameters were checked again after 1 hour in the solution. Results Use of a dry swab resulted in a 0.5mm greater reduction in diameter than the wet swab group. The dry swab group also showed an increase in diameter by 0.5mm when soaked in Hartmann’s solution, this was not seen in the wet swab group. Conclusions Using a dry swab produces a smaller graft diameter, this would allow smaller bone tunnels, retaining bone stock. The subsequent rebound in diameter when in solution may increase the press fit mechanism and facilitate improved integration into the bone tunnel.

Calcium phosphate-hybridised tendon graft to reduce bone-tunnel enlargement after ACL reconstruction in goats

The Knee ◽  
2012 ◽  
Vol 19 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Hirotaka Mutsuzaki ◽  
Masataka Sakane ◽  
Hiromi Nakajima ◽  
Naoyuki Ochiai
Keyword(s):  
Calcium Phosphate ◽  
Acl Reconstruction ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Tunnel Enlargement ◽  
Bone Tunnel Enlargement

scholarly journals QUADRICEP TENDON TURNDOWNS FOR MPFL RECONSTRUCTION: AN ANATOMICAL DIFFERENCE BETWEEN THE ORIGINS OF THE QUADRICEP TENDON AND MPFL ON THE PATELLA

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Audrey Rustad ◽  
Nicolas G. Anchustegui ◽  
Stockton Troyer ◽  
Cooper Shea ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Mpfl Reconstruction ◽  
Surgical Reconstruction ◽  
Skeletally Immature ◽  
Medial Border ◽  
Text Figure ◽  
Distal Aspect ◽  
Bone Tunnels

Background: Quadriceps tendon (QT) turndowns are an alternative method for medial patellofemoral ligament (MPFL) reconstruction, with several distinct advantages: 1. Avoids the use of patella bone tunnels, which have been associated with patella fracture, 2. Avoids the use of separate incision for hamstring tendon harvest, and 3. Avoids the use of allograft tissue, which adds a significant cost. The disadvantage of the Quad Tendon graft is that the most distal reflection point on the patella may not duplicate the patella origin of the native MPFL. The purpose of this study was to determine whether a QT graft for MPFL reconstruction is anatomically analogous to the native MPFL origin in a skeletally immature population. Methods: Three skeletally immature cadaveric knee specimens (ages 10 and 11, 11) were dissected to reveal the MPFL and QT origins on the patella. The proximal and distal extent of the MPFL was marked on the medial border of the patella. The medial aspect of the quad tendon was reflected as far as possible in both a medial and distal position on the patella, to function as the MPFL graft. The distance was measured between the midpoint of the patellar origin of the MPFL in the coronal plane, and the most distal aspect of the patellar origin of the reflected quad tendon. Results: In the 10, 11, and 11 year-old specimens, the distance between the midpoint of MPFL patellar origin and the QT patellar origin was 3.4 cm, 4.3, and 3.7 mm. In all cases, the QT reflected origin was at least 7 mm anterior to the to native MPFL origin on the medial border of the patella. Conclusion: A disparity exists between the patellar origin of the MPFL and the patellar origin of the quad tendon, with the patellar origin of the MPFL being more medial, more distal, and more posterior than the reflected patellar origin of the QT graft. Surgeons performing MPFL reconstructions may find this anatomically valuable as they attempt to duplicate the normal anatomy of the patella stabilizers during surgical reconstruction. While the QT remains a good graft choice for MPFL reconstruction, attachment of the QT graft at the native origin of the MPFL may better reproduce the anatomy of the MPFL. Figures: [Figure: see text][Figure: see text]

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