scholarly journals Influence of Graft Bending Angle on Graft Maturation, the Femoral Tunnel, and Functional Outcomes by 12 Months After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988266
Author(s):  
Hong Li ◽  
Shaohua Liu ◽  
Yaying Sun ◽  
Hongyun Li ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Bending Angle ◽  
Cruciate Ligament Reconstruction ◽  
Functional Scores ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Background: The graft bending angle (GBA), the angle between the femoral bone tunnel and the line connecting the femoral and tibial tunnel apertures, has been proven to influence stress within the graft and could be an important factor in graft healing within the joint and bone tunnel. However, the influence of the GBA on functional outcomes, particularly on return to sports (RTS), is rarely reported. Purpose/Hypothesis: The purpose of this study was to investigate the influence of the GBA on graft maturation, the femoral tunnel, and functional outcomes at 12 months after anterior cruciate ligament reconstruction (ACLR). We hypothesized that a greater GBA might be related to bone tunnel widening, poor graft healing, and inferior functional outcomes after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 43 consecutive patients who underwent unilateral ACLR with hamstring tendon autografts participated in this study. Their knees were evaluated using functional scores (International Knee Documentation Committee [IKDC] score, Lysholm knee activity score, Tegner activity scale, RTS) and the anterior tibial translation side-to-side difference (ATTD), as measured using a KT-1000 arthrometer and 3.0-T magnetic resonance imaging (MRI), at 12 months after surgery. Based on MRI, the signal/noise quotient (SNQ) of the graft, the GBA, and the femoral tunnel diameter were measured. Results: The mean GBA was 56° (range, 41°-69°). The GBA had a significant positive correlation with the SNQ (rho, 0.45; P = .003) and bone tunnel diameter (rho, 0.35; P = .02), but it had no significant correlation with any functional scores. Patients were divided into 3 groups based on GBA values: low GBA (LGBA; 40° < GBA ≤ 50°), middle GBA (MGBA; 50° < GBA ≤ 60°), and high GBA (HGBA; 60° < GBA ≤ 70°). The HGBA group had a significantly higher mean SNQ than both the LGBA ( P = .01) and MGBA groups ( P = .02). It also had a greater mean tunnel diameter than the LGBA group ( P = .04). There was no significant difference in IKDC scores, Lysholm scores, ATTD, Tegner scores, or rates of RTS among groups. Conclusion: The GBA did not affect functional outcomes at 12 months after ACLR, although it affected the SNQ of the graft and the femoral tunnel diameter.

scholarly journals A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901988881
Author(s):  
Shinya Yanagisawa ◽  
Masashi Kimura ◽  
Keiichi Hagiwara ◽  
Atsuko Ogoshi ◽  
Tomotaka Yoneyama ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Posterolateral Bundle ◽  
Bending Angle ◽  
Cruciate Ligament Reconstruction ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Group D

Purpose: The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. Methods: Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone double-bundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of ≥27° were classified as group A, while those with a coronal GBA of <27° were classified as group B, those with a coronal GBA of FPLT of ≥23° were classified as group C, while those with a coronal GBA of<23° were classified as group D. Results: Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D ( p = 0.001). Conclusions: A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.

scholarly journals Anteromedial Portal Double-Bundle Anterior Cruciate Ligament Reconstruction Yields Similar Outcomes to Non-AMP Femoral Drilling Double-Bundle Techniques: A Systematic Review of Comparative Studies

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988814 ◽  
Author(s):  
Tushar Tejpal ◽  
Arnav Gupta ◽  
Ajaykumar Shanmugaraj ◽  
Nolan S. Horner ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Functional Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anteromedial Portal ◽  
Bending Angle ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Biomechanical studies have shown double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) to have increased anterior and rotational stability as compared with single-bundle ACLR. Various techniques exist to drill the femoral tunnel, such as anteromedial portal (AMP), outside-in (OI), and transtibial (TT) drilling. However, it is unclear whether one drilling technique is superior to others when a DB graft is used. Purpose: To systematically assess the outcomes and complications in patients undergoing DB ACLR through an AMP technique as compared with other femoral drilling techniques. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, Medline, and EMBASE databases were searched in April 2018. Nonrandomized studies were assessed with the MINORS (Methodological Index for Nonrandomized Studies), whereas randomized studies were assessed with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Results: Ten studies comprising 722 patients satisfied the inclusion criteria. A total of 351 patients underwent DB ACLR with AMP drilling (mean ± SD age, 32.7 ± 4.7 years); 318 patients had DB ACLR with OI drilling (age, 31.9 ± 4.1 years); and 53 received a DB ACLR with TT drilling (age, 26.5 ± 2.0 years). Graft types used included hamstring autograft (74.1%; n = 247), tibialis anterior autograft (6.0%; n = 20) and unspecified grafts (19.8%; n = 66). No significant difference in postoperative Tegner and Lysholm scores was found between the AMP and OI groups postoperatively. The AMP group had a lower anterior and posterior graft bending angle as compared with the OI group. Four patients (1.1%) in the AMP group had graft reruptures, as compared with 9 reruptures (2.8%) in the OI group. There were no reports of rerupture in the TT group. Conclusion: DB AMP ACLR results in significantly improved functional outcome scores postoperatively. AMP techniques yield similar functional outcomes to OI ACLR. No direct comparison in functional outcomes scores were available between the AMP and TT techniques. Low overall complication and revision rates were observed for patients undergoing DB AMP ACLR and were found to be similar to those of other femoral drilling techniques. Owing to a steeper graft bending angle in patients undergoing OI or TT ACLR relative to AMP ACLR, patients treated with OI or TT femoral drilling may have increased strain placed on the graft. Based on the various limitations in the available literature, it is not currently possible to make a definite conclusion of whether AMP is superior to non-AMP techniques in the setting of DB ACLR.

Sign in / Sign up

Export Citation Format

Share Document