scholarly journals Influence of Graft Bending Angle on Femoral Tunnel Widening After Double-Bundle ACL Reconstruction: Comparison of Transportal and Outside-In Techniques

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110357
Author(s):  
Do Kyung Lee ◽  
Jun Ho Kim ◽  
Byung Hoon Lee ◽  
Hyeonsoo Kim ◽  
Min Jae Jang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Pearson Correlation ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Bending Angle ◽  
Graft Bending Angle ◽  
Significant Difference ◽  
Double Bundle Acl Reconstruction

Background: Previous studies have suggested that increased mechanical stress due to acute graft bending angle (GBA) is associated with tunnel widening and graft failure after anterior cruciate ligament (ACL) reconstruction. Few studies have compared the GBA between the outside-in (OI) and the transportal (TP) techniques. Purpose: To evaluate the influence of GBA on clinical outcomes and tunnel widening after ACL reconstruction with OI versus TP technique. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were 56 patients who underwent double-bundle ACL reconstruction (n = 28 in the OI group and n = 28 in the TP group). Clinical outcomes (Lysholm, International Knee Documentation Committee, Tegner score, and knee laxity) 1 year postoperatively were evaluated. Computed tomography scans at 5 days and 1 year postoperatively were used for imaging measurements, and the femoral tunnel was divided into the proximal third, middle, and aperture sections. The GBA and cross-sectional area (CSA) were measured using image analysis software and were compared between groups. A correlation analysis was performed to determine if the GBA affected clinical outcomes or tunnel widening. Results: No significant difference was observed in clinical outcomes between the groups. The GBA of both the anteromedial (AM) and posterolateral bundles were more acute in the OI group compared with the TP group ( P < .05). The CSA at the AM tunnel aperture increased significantly in the OI group (84.2% ± 64.3%) compared with the TP group (51.4% ± 36.7%) ( P = .04). However, there were no differences in the other sections. In the Pearson correlation test, GBA was not correlated with tunnel widening or clinical outcomes. Conclusion: Regardless of technique, the GBA did not have a significant influence on tunnel widening or clinical outcomes. Considering a wider AM tunnel aperture, a more proximal and posterior AM tunnel position might be appropriate with the OI technique.

A CT based evaluation of femoral and tibial tunnel widening after double bundle ACL reconstruction

2020 ◽  
Vol 7 (4) ◽  
pp. 206-210
Author(s):  
Shekhar Tank ◽  
Saurabh Dutt ◽  
Rakesh Sehrawat ◽  
Dhananjaya Sabat ◽  
Vinod Kumar
Keyword(s):  
Acl Reconstruction ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Double Bundle Acl Reconstruction

scholarly journals The serial changes of static anterior tibial subluxation on MRI after double-bundle anterior cruciate ligament reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0049
Author(s):  
Hideaki Fukuda ◽  
Takahiro Ogura ◽  
Kenji Takahashi ◽  
Shigehiro Asai
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Double Bundle ◽  
Medial Compartment ◽  
Injury Group ◽  
Significant Difference ◽  
Anterior Tibial ◽  
Text Figure ◽  
Double Bundle Acl Reconstruction

Objectives: Static anterior tibial subluxation after an anterior cruciate ligament (ACL) injury highlights the abnormal relationship between the tibia and femur in patients with ACL insufficiency. One of the aims of ACL reconstruction is to restore the normal tibiofemoral relationship. However, several studies indicated that an abnormal tibiofemoral relationship remained after single-bundle (SB) ACL reconstruction. The purpose of this study was to determine the serial changes of static relationship between tibia and femur in patient who had double-bundle ACL reconstruction with acute and chronic injuries. Methods: Thirty five patients who underwent double-bundle ACL reconstruction between January 1 to July 31, 2017 were included in this prospective study and divided two groups: the acute ACL injury group and the chronic ACL injury group (more than 6 month after injury). All participants underwent preoperative and postoperative magnetic resonance imaging (MRI) at 3 weeks, 3, 6 and 12 months. Anterior tibial subluxation (ATS) of the medial and lateral compartments relative to the femoral condyles were measured on MRI. Results: There were no significant differences in the age and KT side to side difference between both groups (Table 1). The ATS measurements are shown in table 2. In lateral compartment, the ATS in the acute ACL injury group was 5.3mm before surgery, while it was -0.31mm, 3.4mm, 3.5mm and 4.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 6.7mm before surgery, while it was 0.47mm, 3.9mm, 4.6mm and 5.9mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups. In medial compartment, the ATS in the acute ACL injury group was 1.8mm before surgery, while it was -1.6mm, 0.28mm, 0.93mm and 2.1mm at 3 weeks, 3, 6, 12months after surgery, respectively. The ATS in the chronic ACL injury group was 2.5mm before surgery, while it was -1.4mm, 1.6mm, 1.7mm and 3.0mm at 3 weeks, 3, 6, 12months after surgery, respectively. No significant difference was found between 2 groups. Conclusion: In both of lateral and medial compartment, the ATS was not significant different between acute and chronic ACL injuries before surgery. In lateral compartment, at 3 weeks, 3months and 6months after surgery, ATS was significantly less than before surgery in both groups. At 12 months, ATS was not significant different from before surgery in both groups. In medial compartment, at 3 weeks, ATS were significantly less than before surgery in both groups. After 3 months, ATS was not significant different from before surgery in both groups. The ATS was not significant different between acute and chronic ACL injuries in the same period after surgery. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

scholarly journals Comparison of Clinical Outcomes Following Anatomic Single vs. Double-Bundle ACL Reconstruction: A Randomized Clinical Trial

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0024
Author(s):  
James J. Irrgang ◽  
Scott Tashman ◽  
Charity Moore ◽  
Volker Musahl ◽  
Robin Vereeke West ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Double Bundle ◽  
Double Bundle Acl Reconstruction

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

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
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.

scholarly journals Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yusuke Kawanishi ◽  
Makoto Kobayashi ◽  
Sanshiro Yasuma ◽  
Hiroaki Fukushima ◽  
Jiro Kato ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Acl Injuries ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Grade 3 ◽  
Double Bundle Acl Reconstruction

Abstract Purpose High-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement. Methods Patients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia. Results In total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05). Conclusion According to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift. Level of evidence IV

Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison

2020 ◽  
Author(s):  
Takuya Tajima ◽  
Nami Yamaguchi ◽  
Yudai Morita ◽  
Makoto Nagasawa ◽  
Tomomi Ota ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Bone Tunnel ◽  
Tunnel Enlargement ◽  
Bone Tunnel Enlargement ◽  
Asian Patients ◽  
Significant Difference ◽  
Double Bundle Acl Reconstruction

AbstractFor anterior cruciate ligament (ACL)-deficient patients, using a single bone-patellar tendon-bone (BPTB) graft for the double-bundle concept is one of the suitable approaches for acquiring better stability and reducing bone tunnel enlargement compared with the use of hamstring grafts. At least 10-mm width of BPTB autograft is needed to achieve this concept; however, it is larger than one-third of the patellar tendon width for small or middle physique patients. This study aimed to assess the clinical and radiographic outcomes of BPTB and gracilis (G) composite autografts for primary double-bundle ACL reconstruction in Asian athletes. Thirty-two Asian patients undergoing double-bundle ACL reconstruction with 7.0 to 7.5 mm of BPTB and 5.0 to 5.5 mm of G composite grafts were compared with 43 double-bundle ACL reconstruction with hamstring graft cases. The BPTB graft was used for the anteromedial bundle (AMB), with the G graft for the posterolateral bundle (PLB). Percentage of femoral bone tunnel enlargement compared with the original size was determined by computed digital radiographs on the first postoperative day and at 12 months in the anteroposterior (AP) and lateral views. Standard clinical evaluations, including the limb symmetry index (LSI), were also performed. Less PLB tunnel enlargement was found in the BPTB + G group than in the hamstring group in the AP (101.9 ± 22.9 vs.113.7 ± 20.6%, p = 0.031) and lateral views (104.4 ± 18.1 vs. 120.6 ± 23.4%, p < 0.01).There was no significant difference between the groups in 12-month postoperative clinical outcomes (Lysholm's score, Tegner's activity level scale, and International Knee Documentation Committee subjective knee evaluation score).The side-to-side difference was significantly less in the BPTB + G group (0.2 ± 1.3 vs. 0.9 ± 1.1 mm, p = 0.026). Despite the small sizes of the BPTB and G grafts, there was no significant difference in the knee extensor LSI between the groups (92.9 ± 10.1 vs. 93.3 ± 12.2%, p = 0.707), whereas the knee flexor LSI was significantly higher in the BPTB + G group (97.7 ± 14.8 vs. 90.1 ± 13.3%, p = 0.033). Double-bundle ACL reconstruction with a small size BPTB and G composite graft procedure provided good clinical outcomes and significantly less femoral bone tunnel enlargement than the hamstring procedure 12 months after surgery. It is thus a useful surgical option for ACL-deficient Asian athletes. This study reflects level of evidence III.

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