PEDIATRIC ACL RECONSTRUCTION: DOES THE FEMORAL PEEK IMPLANT CAUSE TUNNEL WIDENING?

Background: Because of their strength, inertness and biocompatibility, polyetherketone (PEEK) implants have been increasingly used in orthopedics, especially trauma and spine surgeries. Their mechanical and chemical properties have been widely studied and compared to other materials since their accelerated development in the 1980s. Their use is relatively new in anterior cruciate ligament reconstructions (ACLR), and there is little literature to document their effect on tunnel widening in these procedures. Bone tunnel enlargement following ACLR is a widely reported phenomenon that has been negatively correlated with clinical outcome scores. A recent prospective study reiterated its stronger association with suture discs compared with methods using interference screws, cross-pins and buttons. There is only one paper that specifically reports the results of a study on PEEK implants in relation with tunnel widening and it did not demonstrate significant association. PEEK polymer has not yet been studied in pediatric knees, in which tunnel widening has more than the usual residual laxity and re-tear implications, as it can also cause physeal damage. The purpose of this study was to investigate the use of a femoral PEEK implant in ACLR performed on skeletally immature patients and to determine if it is associated with tunnel widening. As a secondary objective, this study aimed to assess the risk of growth complications associated with the use of PEEK. Methods: All patients who underwent all-epiphyseal ACLR surgery in a pediatric university hospital between March 2015 and January 2017 were included in this retrospective study. The all-epiphyseal ACL reconstruction procedures were done using a new instrumentation system that includes a titanium tibial anchor fixation and a femoral PEEK screw system. Femoral bone tunnel diameters were measured on postoperative lateral knee radiographs. The widest tunnel measurements were taken using the sclerotic tunnel margins as reference points and compared to the known sizes of the drill bits retrieved from operative protocols. Paired t tests were performed to assess bone tunnel widening. P-values <0.05 were considered significant. SPSS 25.0 was used for statistical analysis. Results: Eighteen (19 knees) arthroscopic ACL reconstruction patients were included. Of the 18 all-epiphyseal ACL reconstruction patients, 4 (22.2%) were female and 14 (77.8%) were male. The chronological and bone ages at time of surgery (mean ± SD) were respectively 13.5 ± 1.6 and 13.3 ± 1.0 years. At a mean follow-up of 17.1 months, average tunnel enlargement was 1.8± 1.4 (0.0-4.2) mm at the femur and was found to be statistically significant (P<0.001). There were no symptomatic growth abnormalities requiring intervention, but 2 unilateral early physeal closures at the distal femur (10.5%) were noted. These patients had notable femoral tunnel enlargement. One had a 3.0 mm of femoral tunnel widening and no observable growth disturbance. The other had an asymptomatic and non-progressive unilateral knee valgum of 5 degrees and 3.5 mm of femoral tunnel widening. Conclusions/significance: This study showed that the largest tunnel increase at a mean follow up of 17.1 months was 4.2 mm. It is not clear that this widening is clinically significant even though it is statistically significant. Also, association between femoral tunnel widening and physeal closure could not be formally established. Thus, further research on this potential risk factor is needed.

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Bone Tunnel Enlargement after ACL Reconstruction with Hamstring Autograft Is Dependent on Original Bone Tunnel Diameter

The Surgery Journal ◽

10.1055/s-0037-1603950 ◽

2017 ◽

Vol 03 (02) ◽

pp. e96-e100 ◽

Cited By ~ 3

Author(s):

Steffen Sauer ◽

Martin Lind

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Preoperative Evaluation ◽

Bone Tunnel ◽

Tunnel Widening ◽

Tunnel Enlargement ◽

Hamstring Autograft ◽

Bone Tunnel Enlargement ◽

Tibial Bone ◽

Tunnel Diameter

Background Bone tunnel enlargement is a well-established phenomenon following anterior cruciate ligament (ACL) reconstruction, and is related to soft tissue grafts, suspension fixation devices, and absorbable implants. Severe tunnel enlargement can lead to reconstruction failure. The correlation between bone tunnel enlargement following ACL reconstruction and original bone tunnel diameter has not been elucidated. Purpose To determine whether bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original tunnel diameter established during primary ACL reconstruction. Materials and Methods A retrospective review was conducted on 56 patients scheduled for ACL revision surgery who had undergone computed tomography (CT) scanning as part of their preoperative evaluation. All patients had undergone previous hamstring ACL reconstruction. Original femoral and tibial bone tunnel diameters were extracted from operative reports, and femoral and tibial bone tunnel enlargement was assessed on CT serial sections. The correlation between original tunnel diameter and bone tunnel enlargement was investigated using regression analysis. Results Mean tibial bone tunnel enlargement was significantly and inversely dependent on the original tibial bone tunnel diameter with a correlation coefficient of −0.55 per unit (7 mm = +1.93 mm, 8 mm = +1.43 mm, 9 mm = 0.83 mm, p = 0.007). Thus, every additional increase (mm) in diameter of the original tibial bone tunnel reduces the extend of tunnel widening by 0.55 mm. Conclusions The results of this study indicate that tibial bone tunnel enlargement following ACL reconstruction is dependent on original tibial bone tunnel diameter with smaller diameter tunnels developing more tunnel enlargement than larger tunnels. The contributing factors remain unclear and need to be further investigated.

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Comparison of tunnel widening between interference screw and suture disc fixation after ACL reconstruction using CT scan

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180510 ◽

2018 ◽

Vol 4 (2) ◽

pp. 266

Author(s):

Athar Ahemad ◽

Anand B. Anerao

Keyword(s):

Ct Scan ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Interference Screw ◽

Bone Tunnel ◽

Tunnel Widening ◽

Tunnel Enlargement ◽

Suspensory Fixation ◽

The Difference ◽

Student’S T

Background: It is important to study the cause of tunnel widening which occurs after anterior cruciate ligament (ACL) reconstruction as it may affect tendon to bone healing. Amount of tunnel enlargement that happens after different fixation methods like interference screw or suture discs needs to be compared.The objective of the study was to test the hypothesis that aperture fixation (interference screw) reduces tunnel enlargement compared to suspensory fixation (suture disc) due to reduced graft tunnel motion.Methods: 24 bone tunnel diameters in 12 patients were evaluated by CT scan postoperatively after ACL reconstruction to measure tunnel widening. Two groups were formed, one consisting of 14 tunnels fixed by interference screws (IFS) and other consisting of 10 tunnels fixed with suture disc (SD). The difference between the two groups was compared by unpaired student’s t test.Results: The mean tunnel widening in IFS group was 0.414mm while that in the SD group was 1.23mm. The difference between the means of the two groups was statistically significant (p<0.001). Conclusions: Tunnel widening phenomenon was significantly less with anatomic IFS fixation as compared to suture disc fixation probably due to reduced motion of graft within the walls of bony tunnel and consequently better graft healing.

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

The Journal of Knee Surgery ◽

10.1055/s-0040-1722568 ◽

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.

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

The Journal of Knee Surgery ◽

10.1055/s-0038-1675599 ◽

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.

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Computed tomographic evaluation of bone tunnel enlargement following single bundle anterior cruciate ligament reconstruction with hamstring autograft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214967 ◽

2021 ◽

Vol 8 (1) ◽

pp. 81

Author(s):

Sunil Chandrashekar ◽

Manjunath A. N. ◽

Shivakumar M. S.

Keyword(s):

Femoral Tunnel ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Single Bundle ◽

Knee Score ◽

Tunnel Enlargement ◽

Hamstring Autograft ◽

Tunnel Diameter ◽

Anterior Cruciate

The purpose of this study is to evaluate tibial and femoral tunnel diameter following single bundle anterior cruciate ligament (ACL) reconstruction and correlation between tunnel enlargement and clinical outcome. Twelve patients who underwent primary arthroscopic single bundle ACL reconstruction with hamstring graft were included in prospective case series. Preoperative clinical evaluation was performed using international knee documentation committee (IKDC) subjective score and grade, Tegner knee score and Lysholm knee score. Computed tomography (CT) evaluation of the femoral and tibial tunnels were done on post-operative day (POD) 1 and at a mean follow up of 9 months (range 7-12 months) and were compared with functional scores. Our study shows significant tibial and femoral tunnel enlargement on CT scan at 9 months (range 7-12 months) postoperatively. All the clinical evaluation scales showed improvement postoperatively. The mean average femoral tunnel diameter increased significantly (p<0.001) from 8.17±0.57 to 9.08±0.660 (10%) and tibial tunnel diameter increased significantly (p<0.001) from 8.08±0.669 to 9.07±0.601 (11%) postoperatively at a mean follow up of 9 months (range 7-12 months). No statistically significant difference between tunnel enlargement and clinical values were found. In our current prospective CT based study, we conclude use of extracortical fixation of femoral tunnel with stronger fixation of the tibial tunnel, tunnel orientation and anatomic fixation close to the joint line along with less aggressive rehabilitation protocol with use of extension knee brace may result in minimization of tunnel widening with quadrupled hamstring autograft.

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Accessory Anteromedial Portal may not Provide Clinically Superior Results Compared with the Anteromedial Portal in Anterior Cruciate Ligament Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0037-1607074 ◽

2017 ◽

Vol 31 (08) ◽

pp. 716-722

Author(s):

Shu-Ming Ye ◽

Jue-Hua Jing ◽

Hao Lv ◽

Ji-Sen Zhang ◽

Xin-Zhong Xu ◽

...

Keyword(s):

Acl Reconstruction ◽

Femoral Tunnel ◽

Pivot Shift ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Pivot Shift Test ◽

Single Bundle ◽

Anteromedial Portal ◽

Anterior Cruciate

AbstractTechniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.

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Clinical study of anatomical ACL reconstruction using a rounded rectangular dilator

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03913-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Junsuke Nakase ◽

Yasushi Takata ◽

Kengo Shimozaki ◽

Kazuki Asai ◽

Rikuto Yoshimizu ◽

...

Keyword(s):

Acl Reconstruction ◽

Femoral Tunnel ◽

Clinical Results ◽

Hamstring Tendon ◽

Bone Tunnel ◽

Anterior Tibial Translation ◽

Single Bundle ◽

Tunnel Enlargement ◽

Bone Tunnel Enlargement ◽

Tibial Translation

Abstract Background The aim of this study was that to compare clinical results between the rounded rectangular femoral tunnel ACL reconstruction (RFTR) and the conventional round femoral tunnel ACL reconstruction using a hamstring tendon. The hypothesis was that ACL reconstruction performed using the rounded rectangular dilator technique was better than that performed using the conventional round femoral tunnel technique in terms of clinical results and bone tunnel enlargement. Methods We conducted retrospective study. After exclusions, 40 patients were included in the conventional anatomical single-bundle ACL reconstruction (ASBR) group and 40 patients were included in the RFTR group. The evaluation items were knee stability, Lysholm knee score, IKDC subjective score at 2 years after surgery and bone tunnel enlargement. Results The RFTR group had a larger femoral tunnel area (average area, 53.1 ± 4.0 mm2 vs. 46.1 ± 7.0 mm2; P < 0.01), better anteroposterior stability, and higher Lysholm scores than the ASBR group (average side-to-side difference for anterior tibial translation, 0.6 ± 0.8 mm vs. 1.6 ± 1.4 mm; P < 0.01; average Lysholm score, 98.5 ± 2.1 vs. 97.5 ± 3.5; P < 0.01). Further, bone tunnel enlargement ratio was significantly lower in the RFTR group (73 ± 38% vs. 107 ± 41%; P < 0.01). Conclusions We designed and developed an original rounded rectangular dilator to perform a novel ACL surgery. This technique can create a larger bone tunnel and improve clinical results than the conventional round anatomical single-bundle ACL reconstruction.

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Effect of Demineralized Bone Matrix, Bone Marrow Mesenchymal Stromal Cells, and Platelet-Rich Plasma on Bone Tunnel Healing After Anterior Cruciate Ligament Reconstruction: A Comparative Micro-Computed Tomography Study in a Tendon Allograft Sheep Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211034166 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110341

Author(s):

Adam T. Hexter ◽

Aikaterina Karali ◽

Alex Kao ◽

Gianluca Tozzi ◽

Nima Heidari ◽

...

Keyword(s):

Femoral Tunnel ◽

Demineralized Bone Matrix ◽

Platelet Rich Plasma ◽

Cruciate Ligament ◽

Bone Matrix ◽

Bone Tunnel ◽

Bone Volume ◽

Tunnel Widening ◽

Micro Computed Tomography ◽

Anterior Cruciate

Background: The effect of demineralized bone matrix (DBM), bone marrow–derived mesenchymal stromal cells (BMSCs), and platelet-rich plasma (PRP) on bone tunnel healing in anterior cruciate ligament reconstruction (ACLR) has not been comparatively assessed. Hypothesis: These orthobiologics would reduce tunnel widening, and the effects on tunnel diameter would be correlated with tunnel wall sclerosis. Study Design: Controlled laboratory study. Methods: A total of 20 sheep underwent unilateral ACLR using tendon allograft and outside-in interference screw fixation. The animals were randomized into 4 groups (n = 5 per group): Group 1 received 4mL of DBM paste, group 2 received 10 million BMSCs in fibrin sealant, group 3 received 12 mL of activated leukocyte-poor platelet-rich plasma, and group 4 (control) received no treatment. The sheep were euthanized after 12 weeks, and micro-computed tomography scans were performed. The femoral and tibial tunnels were divided into thirds (aperture, midportion, and exit), and the trabecular bone structure, bone mineral density (BMD), and tunnel diameter were measured. Tunnel sclerosis was defined by a higher bone volume in a 250-µm volume of interest compared with a 4-mm volume of interest surrounding the tunnel. Results: Compared with the controls, the DBM group had a significantly higher bone volume fraction (bone volume/total volume [BV/TV]) (52.7% vs 31.8%; P = .020) and BMD (0.55 vs 0.47 g/cm3; P = .008) at the femoral aperture and significantly higher BV/TV at femoral midportion (44.2% vs 32.9%; P = .038). There were no significant differences between the PRP and BMSC groups versus controls in terms of trabecular bone analysis or BMD. In the controls, widening at the femoral tunnel aperture was significantly greater than at the midportion (46.7 vs 41.7 mm2; P = .034). Sclerosis of the tunnel was common and most often seen at the femoral aperture. In the midportion of the femoral tunnel, BV/TV ( r = 0.52; P = .019) and trabecular number ( r S = 0.50; P = .024) were positively correlated with tunnel widening. Conclusion: Only DBM led to a significant increase in bone volume, which was seen in the femoral tunnel aperture and midportion. No treatment significantly reduced bone tunnel widening. Tunnel sclerosis in the femoral tunnel midportion was correlated significantly with tunnel widening. Clinical Relevance: DBM might have potential clinical use to enhance healing in the femoral tunnel after ACLR.

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Single-Bundle versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial with 6-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0037-1598176 ◽

2017 ◽

Vol 30 (09) ◽

pp. 898-904 ◽

Cited By ~ 10

Author(s):

Francesco Dini ◽

Laura de Girolamo ◽

Massimo Cattani ◽

Michele Rosa ◽

Paolo Adravanti

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Double Bundle ◽

Lysholm Score ◽

Single Bundle ◽

Randomized Controlled ◽

Anterior Cruciate

AbstractSingle-bundle (SB) anterior cruciate ligament (ACL) reconstruction is increasingly used in a large number of patients and it allows obtaining very good clinical and subjective results; however, functional tests show a persistent rotational instability. Biomechanical studies seem to indicate that double-bundle (DB) ACL reconstruction allows to obtain increased anterior and rotational stability compared with SB. The aim of this prospective randomized controlled study was to compare the clinical outcome and the possible osteoarthritic evolution of patients treated either with a SB (freehand transtibial femoral tunnel) or with a DB technique (outside-in for posterolateral femoral tunnel/inside-out for anteromedial femoral tunnel) at a final follow-up of 6 years. A total of 60 patients with complete ACL rupture (age, 16–40 years) were prospectively randomized to SB (n = 30) or DB (n = 30) groups. Patients were evaluated preoperatively and after surgery at 6 months, 1, 3, and 6 years with Lysholm score, International Knee Documentation Committee (IKDC) form, and KT-2000 (Medmetric Corp). The degree of osteoarthritis (OA) based on the Kellgren–Lawrence grade was also assessed. No significant differences in background factors between the two groups were observed. Homogeneity was also found in term of preoperative Lysholm score, IKDC, and KT-2000 between SB and DB groups. After 6 months from surgery, both groups showed significant improvements for Lysholm, IKDC, and KT-2000 score with respect to preoperative observations (p < 0.001); however, no significant differences have been observed in term of postoperative values between SB and DB groups at each time point (6-year evaluation: Lysholm score 98.14 ± 10.03 and 97.22 ± 12.82; IKDC normal + nearly normal 95 and 100%; KT-2000 1.68 ± 1.26 and 1.03 ± 1.92 for SB and DB, respectively; all p > 0.05). At the final follow-up, three patients (11.11%) in the DB group and two patients (7.69%) in the SB group presented signs of OA progression. Our study did not reveal any advantages in using DB ACL reconstruction in mid- to long-term follow-up in term of clinical outcome and knee stability, as well as in term of OA progression.

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The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients

Journal of Sports Medicine ◽

10.1155/2014/789317 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Konstantinos A. Starantzis ◽

Dimitrios Mastrokalos ◽

Dimitrios Koulalis ◽

Olympia Papakonstantinou ◽

Panayiotis N. Soucacos ◽

...

Keyword(s):

Acl Reconstruction ◽

Femoral Tunnel ◽

Platelet Rich Plasma ◽

Cruciate Ligament ◽

Randomized Study ◽

Tunnel Widening ◽

Double Blind ◽

Reconstruction Surgery ◽

Significant Difference

Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated.Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel.Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers.Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important.

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