scholarly journals Hybrid Transtibial Femoral Preparation for Transphyseal Anterior Cruciate Ligament Reconstruction: A Radiographic Comparison With the Transtibial and Anteromedial Portal Techniques

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110545
Author(s):  
D. Landry Jarvis ◽  
Danica D. Vance ◽  
Emily K. Reinke ◽  
Jonathan C. Riboh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Calculated Data ◽  
Significant Finding ◽  
Anteromedial Portal ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Tunnel Angle

Background: Transphyseal anterior cruciate ligament (ACL) reconstruction remains the most commonly used technique for pubescent patients. The transtibial (TT) drilling technique creates vertical and central femoral tunnels to minimize the physeal area of injury at the expense of a nonanatomic femoral tunnel. The hybrid TT (HTT) technique offers the potential of an anatomic femoral position with tunnel geometry similar to that using the TT technique. Purpose/Hypothesis: The purpose was to perform a radiographic comparison of the HTT technique with TT and anteromedial portal (AM) techniques in adolescent patients undergoing transphyseal ACL reconstruction. It was hypothesized that femoral tunnels created during HTT would be similar to TT tunnels but significantly more vertical and central than AM tunnels. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively screened primary transphyseal ACL reconstructions performed in adolescents at our institution between 2013 and 2019. The youngest 20 eligible patients were selected from each technique cohort: TT, AM, and HTT. Postoperative radiographs were assessed for the coronal femoral tunnel angle, as well as the location of the tunnel-physis penetration on the anteroposterior and lateral views. Physeal lesion surface area was calculated. Data were compared among the 3 groups using 1-way analysis of variance followed by pairwise comparisons. Results: Included were 47 patients with a mean ± SD age of 14.3 ± 1.2 years (n = 9 with TT, 18 with AM, and 20 with HTT techniques). The coronal tunnel angle was significantly more vertical in the TT (60.7° ± 7.2°) and HTT (54.4° ± 5.7) groups as compared with the AM group (48.8° ± 5.9; P = .0037 and P = .02, respectively). There was no significant difference between the TT and HTT groups ( P = .066). The only significant finding regarding femoral tunnel location was that the HTT tunnels (28.9% ± 4.8%) penetrated the physis more centrally than did the AM tunnels (20.0% ± 5.1%; P = .00002) on lateral radiographs. Conclusion: The HTT technique presents an option for transphyseal ACL reconstruction, with femoral tunnel obliquity and estimated physeal disruption similar to that of the TT technique and significantly less than that of the AM technique. The HTT technique also results in the most central physeal perforation of all techniques, predominantly in the sagittal plane.

scholarly journals Hybrid Transtibial Femoral Preparation for Transphyseal Anterior Cruciate Ligament Reconstruction: A Radiographic Comparison to Transtibial and Anteromedial Portal Techniques

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
D.Landry Jarvis ◽  
Danica D. Vance ◽  
Jonathan C. Riboh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sagittal Plane ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Calculated Data ◽  
Anteromedial Portal ◽  
Significant Difference ◽  
Text Figure ◽  
Anterior Cruciate

Background: Transphyseal anterior cruciate ligament (ACL) reconstruction remains the most commonly used technique for pubescent patients. The principles of creating vertical and central femoral tunnels are well accepted to minimize physeal area of injury and are typically accomplished with a transtibial (TT) technique. This, however, may come at the expense of a non-anatomic tunnel. The hybrid transtibial (HTT) technique offers the potential of combining an anatomic femoral position with tunnel geometry similar to the TT technique but has never been assessed in a clinical cohort. Hypothesis/Purpose: We hypothesized that tunnels created by a HTT technique would be similar in orientation and physeal location to TT tunnels, but significantly more vertical and central than tunnels created with an anteromedial portal (AM). Methods: We retrospectively screened all ACL reconstructions performed in children aged 10 to 16 years, at our institution between 2013 to 2019, with the requirements of having a transphyseal reconstruction and an available post-operative radiographs. Radiographs were then assessed for the coronal femoral tunnel angle (FTA), as well as the location of the tunnel-physis penetration on the AP (LTAP) and lateral (LTL) views. Physeal lesion surface area was calculated. Data were compared between the three groups using ANOVA. Results: Forty-seven patients met eligibility criteria with 9 TT, 18 AM, and 20 HTT patients. Mean patient age was 14.3 +/- 1.2 years. The FTA was significantly more vertical in the TT (60.7o +/-7.2) and HTT (54.4o +/- 5.7) groups as compared to the AM group (48.8o +/- 5.9); p = 0.0037 and p = 0.02 respectively. There was no significant difference between the TT and HTT groups ( p = 0.066). The LTAP was not significantly different between groups (p = 0.097). The LTL demonstrated that the HTT tunnels penetrated the physis at a more central location in the sagittal plane (28.9% +/- 4.8%) than the AM tunnels (20.0% +/- 5.1%, p = 0.00002), but was statistically indistinguishable from the TT (24.4%+/- 4.0%, p= 0.066) tunnels. Conclusion: The hybrid transtibial technique presents an option for transphyseal ACL reconstruction, with femoral tunnel obliquity and estimated physeal disruption similar to the TT technique, significantly less than the AM technique. The HTT also results in the most central physeal perforation of all techniques, predominantly in the sagittal plane. With the known ability of the HTT technique to recreate an anatomic femoral footprint, this may represent the “best of both worlds” for transphyseal ACL reconstruction. Tables/Figures: [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

scholarly journals Clinical outcome of anterior cruciate ligament reconstruction with modified transtibial and anteromedial portal

2021 ◽  
Author(s):  
S. Vijayan ◽  
H. Kyalakond ◽  
M. S. Kulkarni ◽  
M. N. Aroor ◽  
S. Shetty ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Functional Outcomes ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anteromedial Portal ◽  
Anterior Drawer ◽  
Significant Difference ◽  
Kt 1000 ◽  
Anterior Cruciate

AbstractArthroscopic ACL reconstruction is the current standard care of treatment for anterior cruciate ligament (ACL) injuries. Modified transtibial (mTT) and anteromedial portal (AMP) techniques aim at the anatomical placement of femoral tunnel. Controversy existed in the literature with regard to the outcome of these techniques. Hence, we designed a retrospective comparative study to analyse the clinical and functional outcomes of mTT and AMP techniques. We hypothesized that there would be no difference between the clinical and functional outcomes in mTT and AMP techniques. This retrospective observational study was conducted in consecutive patients who underwent arthroscopic ACL reconstruction using semitendinosus-gracilis (STG) quadrupled graft in our tertiary care centre with a minimum follow-up of two years. Out of 69 patients, 37 had undergone ACL reconstruction by mTT technique and remaining by AMP technique. All the patients were assessed clinically by anterior drawer, Lachman’s, pivot shift and single-legged hop test. Lysholm Knee Scoring Scale and International Knee Documentation Committee (IKDC) subjective knee evaluation score were used for the functional status. Knee instability was assessed objectively by KT-1000 arthrometer. There was no statistically significant difference in baseline demographic characteristics between mTT and AMP groups. At the end of 2 years, no statistically significant difference was noted in the anterior drawer and Lachman’s test. Though not significant, IKDC scores and Lysholm’s scores showed a better outcome in the AMP group when compared to the mTT group. AMP group showed significantly better outcome with KT-1000 arthrometer. Based on the results obtained, we presume that overall both mTT and AMP have similar functional outcome. However, as AMP technique offers significantly improved subjective rotational stability on pivot shift test, better hop limb symmetry index and KT 1000 readings compared to mTT, we suggest AMP over mTT.

A Simple Evaluation of Anterior Cruciate Ligament Femoral Tunnel Position

2011 ◽  
Vol 39 (12) ◽  
pp. 2611-2618 ◽  
Author(s):  
Kenneth David Illingworth ◽  
Daniel Hensler ◽  
Zachary Mark Working ◽  
Jeffrey Alexander Macalena ◽  
Scott Tashman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Inclination Angle ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
3D Ct ◽  
Tunnel Position ◽  
Femoral Tunnel Position ◽  
Anterior Cruciate ◽  
Tunnel Angle

Background: Postoperative determination of tunnel position after anterior cruciate ligament (ACL) reconstruction can be challenging. Hypothesis: The femoral tunnel angle and inclination angle are reliable methods for evaluating tunnel position after ACL reconstruction while aiding in determining whether an ACL reconstruction falls outside an anatomic range as defined on 3-dimensional (3D) computed tomography (CT). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Fifty patients were included who received single-bundle ACL reconstructions with postoperative flexion weightbearing radiographs, magnetic resonance imaging (MRI), and CT scans. Femoral tunnel angles were determined from posterior-to-anterior postoperative radiographs, and inclination angles were determined from sagittal MRI. The ACL reconstructions were grouped by surgical technique, transtibial (TT) or tibial tunnel independent (TTI), and as either falling inside or outside an anatomic range on 3D CT. Results: Patients with tunnel positions within an anatomic range, as previously defined, had a larger femoral tunnel angle (39.3° ± 4.2°) and smaller inclination angle (49.5° ± 2.7°) than patients who fell outside an anatomic range (17.2° ± 12.5° and 62.3° ± 7.8°, respectively) ( P < .001). Patients in the TTI group had a larger femoral tunnel angle (37.6° ± 9.30°) and smaller inclination angle (51.8° ± 6.5°) than those in the TT group (14.2° ± 9.3° and 63.5° ± 7.2°, respectively) ( P < .001). Posterior-to-anterior femoral tunnel position was negatively correlated with femoral tunnel angle ( P < .001, r = .78) and positively correlated with inclination angle ( P < .001, r = .74). Based on a receiver operating characteristic (ROC) curve, a femoral tunnel angle of 32.7° (100% sensitivity and 85% specificity) and inclination angle of 55° (100% sensitivity and 87.5% specificity) were determined to distinguish ACL reconstructions that fell either within or outside an anatomic range on 3D CT. Conclusion: Femoral tunnel angle and inclination angle can be reliably determined from both posterior-to-anterior radiographs and sagittal MRI and provide a useful metric for characterizing femoral tunnel position.

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

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.

scholarly journals Correlation of Femoral Tunnel Length with Body Height, Limb Length, and Thigh Length in Indian Patients Undergoing Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 24 (3) ◽  
pp. 286-288
Author(s):  
Ravi Gupta ◽  
Anubhav Malhotra ◽  
Pawan Kumar ◽  
Gladson David Masih
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Body Height ◽  
Limb Length ◽  
Tunnel Length ◽  
Indian Patients ◽  
Anterior Cruciate ◽  
Hamstrings Tendon

Purpose To measure the femoral tunnel length created through a far medial portal and determine its correlation with body height, limb length, and thigh length in 404 Indian patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods 364 male and 40 female Indian patients aged 18 to 51 (mean, 26.8) years underwent ACL reconstruction by a single surgeon using the hamstrings tendon autograft. Their body height, limb length, and thigh length were measured by a single assessor, as was the femoral tunnel length. Results The mean femoral tunnel length was 34.5 mm. It was <30 mm in 28 patients and <25 mm in 2 patients. The correlation coefficients of the femoral tunnel length with body height, limb length, and thigh length were 0.485 (p<0.0001), 0.426 (p<0.0001), and 0.304 (p<0.0001). No patient had posterior wall blowout fracture. Conclusion The femoral tunnel length positively correlated with body height, limb length, and thigh length in 404 Indian patients.

scholarly journals Computed Tomography Imaging Results of Single Band Anterior Cruciate Ligament Reconstruction: A Retrospective Study Comparing Fixed- and Adjustable-Length Loop Cortical Fixation on the First Day After Surgery

2021 ◽  
Author(s):  
Lifeng Yin ◽  
Hua Zhang ◽  
Junbo Liu ◽  
xingyu zhang ◽  
zhengxing wen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Ct Images ◽  
Graft Fixation ◽  
Bone Preservation ◽  
Anterior Cruciate ◽  
Graft Insertion

Abstract Background: Cortical suspensory femoral fixation is commonly performed for graft fixation of the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. This study aimed to compare the morphology of femoral tunnel and graft insertion between fixed-length loop devices (FLD) and adjustable-length loop devices (ALD) using computed tomography (CT) images on the first day after hamstring ACL reconstruction. Methods: Overall, 94 patients who underwent ACL reconstruction from January 2016 to January 2021 were included. For femoral graft fixation, FLD (Smith & Nephew, ENDOBUTTON) and ALD (DePuy Synthes, Mitek sports medicine, RIGIDLOOP Adjustable cortical system) were used in 56 and 38 patients, respectively (FLD and ALD groups). For evaluation of the morphology of the humeral tunnel and graft depth, CT scans were performed immediately on the first postoperative day. The gap distance between the top of the graft and the socket tunnel end, the length of lateral bone preservation, and the depth of graft insertion were measured on the CT images. Results: The gap distance and bone preservation significantly differed between the two groups (1.90±1.81 mm and 14.35±4.67 mm in ALD groups; 7.08±2.63 mm and 7.35±3.62 mm in FLD groups, respectively; both P values < 0.01). The graft insertion depth did not significantly differ between the groups. Conclusion: The ALD group had a smaller gap distance, better bone preservation, and a similar graft insertion length in the femoral tunnel when compared to the FLD group. Based on these findings, ALD might be better for bone preservation and tunnel utilization in patients with short femoral tunnels. Trial registration: retrospectively registered

scholarly journals Performance of the PROMIS in Patients After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877450 ◽  
Author(s):  
Elizabeth J. Scott ◽  
Robert Westermann ◽  
Nathalie A. Glass ◽  
Carolyn Hettrich ◽  
Brian R. Wolf ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Physical Function ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Floor Effects ◽  
Anterior Cruciate ◽  
Pro Instruments

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is designed to advance patient-reported outcome (PRO) instruments by utilizing question banks for major health domains. Purpose: To compare the responsiveness and construct validity of the PROMIS physical function computer adaptive test (PF CAT) with current PRO instruments for patients before and up to 2 years after anterior cruciate ligament (ACL) reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Initially, 157 patients completed the PROMIS PF CAT, Short Form–36 Health Survey (SF-36 physical function [PF] and general health [GH]), Marx Activity Rating Scale (MARS), Knee injury and Osteoarthritis Outcome Score (KOOS activities of daily living [ADL], sport, and quality of life [QOL]), and EuroQol–5 dimensions questionnaire (EQ-5D) at 6 weeks, 6 months, and 2 years after ACL reconstruction. Correlations between instruments, ceiling and floor effects, effect sizes (Cohen d), and standardized response means to describe responsiveness were evaluated. Subgroup analyses compared participants with and without additional arthroscopic procedures using linear mixed models. Results: At baseline, 6 weeks, and 6 months, the PROMIS PF CAT showed excellent or excellent-good correlations with the SF-36 PF ( r = 0.75-0.80, P < .01), KOOS-ADL ( r = 0.63-0.70, P < .01), and KOOS-sport ( r = 0.32-0.69, P < .01); excellent-good correlation with the EQ-5D ( r = 0.60-0.71, P < .01); and good correlation with the KOOS-QOL ( r = 0.52-0.58, P < .01). As expected, there were poor correlations with the MARS ( r = 0.00-0.24, P < .01) and SF-36 GH ( r = 0.16-0.34, P < .01 ). At 2 years, the PROMIS PF CAT showed good to excellent correlations with all PRO instruments ( r = 0.42-0.72, P < .01), including the MARS ( r = 0.42, P < .01), indicating frequent return to preinjury function. The PROMIS PF CAT had the fewest ceiling or floor effects of all instruments tested, and patients answered, on average, 4 questions. There was no significant difference in baseline physical function scores between subgroups; at follow-up, all groups showed improvements in scores that were not statistically different. Conclusion: The PROMIS PF CAT is a valid tool to assess outcomes after ACL reconstruction up to 2 years after surgery, demonstrating the highest responsiveness to change with the fewest ceiling and floor effects and a low time burden among all instruments tested. The PROMIS PF CAT is a beneficial alternative for assessing physical function in adults before and after ACL reconstruction.

scholarly journals Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Adam T. Hexter ◽  
Anita Sanghani-Kerai ◽  
Nima Heidari ◽  
Deepak M. Kalaskar ◽  
Ashleigh Boyd ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Stromal Cells ◽  
Femoral Tunnel ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Control Group ◽  
Tendon Allograft ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

Sign in / Sign up

Export Citation Format

Share Document