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.

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 Evaluation of a novel lower radiation computed tomography protocol for assessment of tunnel position post anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
varun vasudeva ◽  
Stephen Key ◽  
Alfred Phillips ◽  
Steve Kahane ◽  
Joseph Stevens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Radiation Dose ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Effective Radiation Dose ◽  
Tunnel Position ◽  
Anterior Cruciate ◽  
Conventional Ct

Abstract Background Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is <0.5mSv, which is significantly less than the 2mSv dose for a conventional CT protocol. The aim of this study was to assess the accuracy of the LDCT protocol for determining tunnel position. Methods Twenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed six weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, four weeks apart. Results There was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were >0.9 for all measurements. Conclusions The LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

scholarly journals Effects of Remnant Tissue Preservation on Tunnel Enlargement After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Hamstring Tendon

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881129 ◽  
Author(s):  
Tetsuro Masuda ◽  
Eiji Kondo ◽  
Jun Onodera ◽  
Nobuto Kitamura ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Tissue Preservation ◽  
Tunnel Enlargement ◽  
Level Of Evidence ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction ◽  
Tunnel Positions

Background: The effects of remnant tissue preservation on tunnel enlargement after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction have not yet been established. Hypothesis: The preservation of ACL remnant tissue may significantly reduce the degree and incidence of tunnel enlargement after anatomic double-bundle ACL reconstruction, while the remnant-preserving procedure may not significantly increase the incidence of tunnel coalition after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 79 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 40 patients underwent the remnant-preserving procedure (group P), and the remaining 39 patients underwent the remnant-resecting procedure (group R). There were no differences between the 2 groups concerning all background factors, including preoperative knee instability and intraoperative tunnel positions. All patients were examined using computed tomography and a standard physical examination at 2 weeks and 1 year after surgery. Results: During surgery, the femoral and tibial anteromedial (AM) tunnel sizes in both groups averaged 6.6 and 6.5 mm, respectively. The femoral and tibial posterolateral (PL) tunnel sizes in both groups averaged 6 and 6 mm, respectively. There were no differences in the intraoperative tunnel positions and tunnel sizes between groups. Concerning the femoral AM tunnel, the degree of tunnel enlargement in the oblique coronal and oblique axial views in group P was significantly less than that in group R ( P = .0068 and .0323, respectively). Regarding the femoral AM tunnel cross-sectional area, the degree and incidence of tunnel enlargement in group P were significantly less than those in group R ( P = .0086 and .0278, respectively). There were no significant differences in tunnel coalition between groups. In each group, there were no significant relationships between tunnel enlargement and each clinical outcome. Conclusion: Remnant preservation in anatomic double-bundle ACL reconstruction reduced enlargement of the femoral AM tunnel and did not increase the incidence of tunnel coalition. This is one of the advantages of remnant-preserving ACL reconstruction.

scholarly journals Radiographic analysis of the tibial tunnel position after anterior cruciate ligament reconstruction

2018 ◽  
Vol 71 (1-2) ◽  
pp. 15-20
Author(s):  
Vladimir Ristic ◽  
Nenad Ristic ◽  
Vladimir Harhaji ◽  
Mile Bjelobrk ◽  
Vukadin Milankov
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Operative Procedure ◽  
Cruciate Ligament Reconstruction ◽  
Tunnel Position ◽  
Tibial Tunnel Position ◽  
Anterior Cruciate

Introduction. The aim of the study was to analyze the tibial tunnel position after anterior cruciate ligament reconstruction. Material and Methods. The study included 830 patients who underwent this operative procedure. There were four times more male than female patients. The tibial tunnel placement was analyzed on frontal and lateral radiograph images of the knee joint. Results. The average frontal tibial index was 55% (35 - 68%), the average frontal tibial angle was 75 degrees (58 - 90), the sagittal tibial index was 30% (15 - 52%) and the sagittal tibial angle was 68 degrees (50 - 89). Conclusion. A significant deviation from these values may potentially lead to failure of the anterior cruciate ligament reconstruction.

scholarly journals Influence of the bone block position on the tunnel enlargement in ACL reconstruction

2010 ◽  
Vol 2 (1) ◽  
pp. 12 ◽  
Author(s):  
Dominik Hoigne ◽  
Peter Ballmer
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Average Diameter ◽  
Bone Block ◽  
X Rays ◽  
Tunnel Enlargement ◽  
Tunnel Position ◽  
Anterior Cruciate ◽  
Bone Plug ◽  
Block Position

Tunnel enlargement can appear after anterior cruciate ligament reconstruction. We investigated the influence of the bone block position of a patellar tendon autograft on the tunnel enlargement in the femur and in the tibia from two aspects. On the one hand, we examined the influence of the tunnel position in respect to the ap-diameter. On the other hand, we examined the influence of the bone block depth in respect to the joint line. In a crossover study over three years, 103 knees with primary ACL reconstruction were included. The incidence of tunnel enlargement measured on X-rays after one year was 52% (n=103) in the femur and 81% (n=103) in the tibia. The average diameter of enlargement was 1.4 mm (14%) in the femur and 2.7 mm (27%) in the tibia. No correlation between the tunnel position and the tunnel enlargement in the sagital plane could be found. However, there is a significant positive correlation between the size of tunnel enlargement and the bone block depth in the femur and in the tibia. There is an average tunnel enlargement of about 0.6 mm (6%) per 10 mm deeper bone plug depth. The relative excess length of the patella tendon favors the development of tunnel enlargement. The effect of the bone block depth on the tunnel enlargement is equal in the femur and the tibia.

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