scholarly journals Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097783
Author(s):  
Yuta Tachibana ◽  
Yoshinari Tanaka ◽  
Kazutaka Kinugasa ◽  
Tatsuo Mae ◽  
Shuji Horibe
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Relevant Literature ◽  
Case Series ◽  
Double Bundle ◽  
Tunnel Enlargement ◽  
Cross Sectional ◽  
Computed Tomography Images ◽  
The Cross ◽  
Bone Tunnels

Background: There exists little information in the relevant literature regarding tunnel enlargement after posterior cruciate ligament (PCL) reconstruction (PCLR). Purpose: To sequentially evaluate tunnel enlargement and radiographic posterior laxity through double-bundle PCLR using autologous hamstring tendon grafts. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed 13 patients who underwent double-bundle PCLR for an isolated PCL injury. Three-dimensional computed tomography images were obtained at 3 weeks, 6 months, and 1 year postoperatively, and the tunnel enlargement was calculated by sequentially comparing the cross-sectional areas of the bone tunnels. We also sequentially measured radiographic posterior laxity. The correlation between the tunnel enlargement ratio and the postoperative increase in posterior laxity was evaluated. Results: The cross-sectional area at the aperture in each tunnel significantly increased from 3 weeks to 6 months ( P < .003), but it did not continue doing so thereafter. The 6-month tunnel enlargement ratios of the femoral anterolateral tunnel, the femoral posteromedial tunnel, the tibial anterolateral tunnel, and the tibial posteromedial tunnel were 31.6% ± 23.5%, 90.3% ± 54.7%, 30.5% ± 26.8%, and 49.6% ± 37.0%, respectively, while the corresponding ratios at 1 year were 28.1% ± 19.8%, 83.1% ± 56.9%, 26.8% ± 32.8%, and 47.6% ± 39.0%, respectively. The posterior laxity was 9.0 ± 4.0 mm, −1.5 ± 2.3 mm, 3.4 ± 2.0 mm, and 3.9 ± 1.9 mm, preoperatively, immediately after surgery, 6 months and 1 year postoperatively, respectively. From the immediate postoperative period, the posterior laxity significantly increased at 6 months postoperatively ( P < .001), but it did not thereafter. The postoperative increase in posterior laxity had a significant positive correlation with the anterolateral tunnel enlargement ratio in both femoral and tibial tunnels at 6 months (ρ = 0.571-0.699; P = .011-.041) and 1 year (ρ = 0.582-0.615; P = .033-.037). Conclusion: Tunnel enlargement after PCLR mainly occurred within 6 months, with no progression thereafter. The anterolateral tunnel enlargement positively correlated with postoperative increase in posterior laxity.

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.

Avoiding tibia physeal injury during double-bundle posterior cruciate ligament reconstruction

2018 ◽  
Vol 3 (1) ◽  
pp. 21-25
Author(s):  
Stockton Troyer ◽  
Nicolas G Anchustegui ◽  
Connor G Richmond ◽  
Peter C Cannamela ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Reconstruction Technique ◽  
Pcl Reconstruction ◽  
Turn Angle ◽  
Physeal Injury ◽  
The Impact ◽  
Killer Turn

BackgroundAnatomic studies of the paediatric posterior cruciate ligament (PCL) demonstrate that the tibial attachment spans the epiphysis, physis and metaphysis. To better reproduce the anatomy of the PCL and avoid direct physeal injury, a double-bundle PCL reconstruction technique that includes both an all-epiphysial and an all-metaphyseal tibial tunnel has been proposed. The purpose of this study was to evaluate tibial tunnel placement in a paediatric double-bundle PCL reconstruction technique that avoids direct physeal injury using a 3-D computer model.MethodsTen skeletally immature cadaveric knee specimens (ages 5–11) were used to create 3-D model reconstructions from CT scans. All-metaphyseal and all-epiphysial tibial tunnels were simulated with the goal of maintaining adequate spacing (≥2 mm) between the tibial physis and tunnels to avoid injury. The all-metaphyseal tunnel, simulated at sizes of 5, 6 and 7 mm, entered anteriorly, below the tibial tubercle (apophysis) and exited posteriorly in the metaphyseal PCL footprint, distal to the proximal tibial physis. Four-millimetre all-epiphysial proximal tibial tunnels were simulated to enter the epiphysis anteromedially and exit posteriorly at the central epiphysial region of the PCL footprint, proximal to the physis. The distance was measured from the all-metaphyseal tunnels to the physis posteriorly and from the all-epiphysial tunnels to the physis, both anteriorly and posteriorly.ResultsIn all specimens, the 4 mm all-epiphysial tunnel and the 5, 6 and 7 mm all-metaphyseal tunnels maintained adequate spacing, ≥2 mm from the physis. In the specimens aged 5–7 years, the 5, 6 and 7 mm all-metaphyseal tunnels measured a mean distance of 3.5, 2.8 and 2.5 mm from the physis, respectively. In the specimens aged 8–11 years, the 5, 6 and 7 mm all-metaphyseal tunnels measured a mean distance of 3.4, 2.9 and 2.6 mm from the physis. In the specimens aged 5–7 years, the all-epiphysial tunnel measured a mean of 2.1 mm to the physis anteriorly and a mean of 2.8 mm posteriorly. In the specimens aged 8–11 years, the all-epiphysial tunnel measured a mean of 2.2 mm to the physis anteriorly and 2.4 mm posteriorly.ConclusionThese computer-aided 3-D models of paediatric knees illustrate that 5, 6 and 7 mm all-metaphyseal tunnels as well as 4 mm all-epiphysial tunnels can be placed without direct injury to the proximal tibial physis. The margin of error for direct physeal injury is small, especially for the all-epiphysial tunnel. Further, the all-epiphysial tunnel, while reproducing the anatomy of the PCL epiphysial attachment, may also produce a more extreme ‘killer turn’ of the graft. Modifications to the all-epiphysial tunnel may be considered to reduce the impact of the high ‘killer turn’ angle on the tibia.Level of evidenceIV.

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