scholarly journals Femoral Tunnel Widening Via Transcondylar Cross-Pin Fixation Versus Extracortical Suspensory Fixation After Single-Bundle ACLR: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199381
Author(s):  
Haluk Celik ◽  
Jun-Ho Kim ◽  
Sang-Hak Lee ◽  
Dae-Hee Lee
Keyword(s):  
Systematic Review ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Fixation Method ◽  
Tunnel Widening ◽  
Single Bundle ◽  
Pin Fixation ◽  
Significant Difference ◽  
Suspensory Fixation

Background: Compared with extracortical suspensory fixation, the close-to-joint transcondylar cross-pin fixation method in anterior cruciate ligament reconstruction (ACLR) is believed to entail less intratunnel graft motion and subsequently lead to less tunnel widening. Purpose: To assess femoral tunnel widening via the transcondylar cross-pin method or the suspensory femoral fixation method in patients who had undergone ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: This review focused on studies on femoral-tunnel widening after single-bundle ACLR with cross-pin (Rigidfix or Transfix) and/or Endobutton closed loop (CL). Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACLR. Results: Overall, 19 studies were included in this meta-analysis. There was no significant difference between cross-pin and Endobutton CL fixations in the pooled absolute change in tunnel widening from the immediate postoperative period to the final follow-up; this was true at both the tunnel aperture (2.48 mm [95% CI, 1.76-3.2 mm] vs 2.93 mm [95% CI, 1.73-4.13 mm], respectively; P = .527) and the midpoint of the femoral tunnel (2.43 mm [95% CI, 1.77-3.1 mm] vs 2.54 mm [95% CI, –0.33 to 5.42 mm], respectively; P = .937). No significant difference was found in the relative percentage of femoral-tunnel widening between the 2 fixation methods (cross-pin, 43.3% [95% CI, 25.8%-60.8%] vs Endobutton CL, 42.0% [95% CI, 34.1%-49.9%]; P = .965). Conclusion: No significant difference in femoral tunnel widening was found to be associated with the use of either cross-pin or extracortical suspensory fixation in patients who underwent single-bundle ACLR.

scholarly journals Is Remnant Preservation in Anterior Cruciate Ligament Reconstruction Superior to the Standard Technique? A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Han Wang ◽  
Ziming Liu ◽  
Yuwan Li ◽  
Yihang Peng ◽  
Wei Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Postoperative Knee

Purpose. This is a systematic review and meta-analysis of current evidence that aims at comparing the clinical outcomes of remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR. Methods. A systematic review of randomized controlled studies and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of II was performed. Studies were included by strict inclusion and exclusion criteria. Extracted data were summarized as preoperative conditions, postoperative clinical outcomes, and postoperative complications. When feasible, meta-analysis was performed with RevMan5.3 software. Study methodological quality was evaluated with the modified Coleman methodology score (CMS). Results. Eleven studies (n = 466 remnant-preserving and n = 536 standard) met the inclusion criteria. The mean modified CMS for all included studies was 85.8 (range: 77–92 on a 100-point scale). In total, 466 patients underwent remnant-preserving ACLR by 3 different procedures: standard ACLR plus tibial remnant tensioning (n = 283), selective-bundle augmentation (n = 49), and standard ACLR plus tibial remnant sparing (n = 134). Remnant-preserving ACLR provided a superior outcome of postoperative knee anterior stability (WMD = −0.42, 95% CI, −0.66, −0.17; P<0.01) and Lysholm score (WMD = 2.01, 95% CI, 0.53 to 3.50; P<0.01). There was no significant difference between the two groups with respect to second-look arthroscopy (OR = 1.38, 95% CI, 0.53, 3.62; P=0.51), complications (OR = 1.24 95% CI, 0.76, 2.02; P=0.39), International Knee Documentation Committee (IKDC) subject scores, IKDC grades, Lachman test, and pivot-shift test. Summary/conclusion. Remnant-preserving ACLR promotes similar graft synovial coverage and revascularization to standard ACLR. Equivalent or superior postoperative knee stability and clinical scores were observed for remnant-preserving ACLR compared with standard ACLR. No significant difference in the total complication rate between the groups was evident.

Correlation Between Endobutton Loop Length and Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Nam-Hong Choi ◽  
Jong-Seok Oh ◽  
Seok-Hyun Jung ◽  
Brian N. Victoroff
Keyword(s):  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Significant Difference ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Background: Previous reports have shown that graft fixation with the Endobutton is associated with tunnel widening because it provides distant fixation rather than aperture fixation. Hypothesis: A longer loop of the Endobutton results in greater tunnel widening than a shorter loop. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 171 consecutive patients underwent hamstring anterior cruciate ligament (ACL) reconstruction fixed with the Endobutton. They were followed for a minimum of 2 years postoperatively. A 15-mm loop was used in 20 patients, a 20-mm loop in 53, a 25-mm loop in 58, and a >30-mm loop in 40. On anterior-posterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 2 years after surgery were compared with the diameter of the reamer used at surgery. The measured diameter of the tibial tunnel at 2 years after surgery was compared with measurements taken on the immediate postoperative day. The center of the tibial tunnel and direction of the ACL graft were also measured. Postoperative knee stability was evaluated using the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. All measurements were compared among the 4 groups according to the length of the Endobutton loop. Results: The mean ± standard deviation (SD) diameter of the femoral tunnel increased by 50.7% ± 23.3% and 37.0% ± 18.8% on AP and lateral radiographs at 2 years after surgery, respectively. The mean ± SD diameter of the tibial tunnel increased by 40.8% ± 19.3% and 46.4% ± 22.6% on AP and lateral radiographs, respectively. No significant difference in tunnel widening was present according to the length of the Endobutton loop. There were no significant differences in the average center of the tibial tunnel or the average angle of the direction of the ACL graft among the 4 groups. There was no significant difference in Lachman test results, postoperative KT-1000 arthrometer side-to-side differences, Lysholm score, and Tegner activity scale score among the 4 groups. The group with a >30-mm loop showed a significant difference in the pivot-shift test than the other 3 groups ( P = .023). Conclusion: A longer Endobutton loop did not result in greater tunnel widening than a shorter loop. Long fixation distance may not be associated with tunnel widening after hamstring ACL reconstructions.

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 Comparison of tunnel expansion, isometric muscle strength and clinical condition after anterior cruciate ligament reconstruction with single- or dual-bundle

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Salih Beyaz ◽  
Ümit Özgür Güler ◽  
Şenay Demir ◽  
Selcen Pehlivan ◽  
Bekir Murat Çınar ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Scoring Systems ◽  
Peak Torque ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Single Bundle ◽  
Significant Difference ◽  
Anterior Cruciate

Thirty-one patients who suffered anterior cruciate ligament (ACL) injury and underwent ACL reconstruction (16 single-bundle, 15 double-bundle) with ENDOBUTTON between November 2007 and March 2008 were included in the study. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles at the 6th month and 8th year were made using a Biodex 3 device at angular velocities of 60°/sec, 120°/sec and 180°/sec. The peak torque and peak torque to body weight ratios were recorded. 3D-CT scans of the joints were performed on the 2nd, 3 rd and 6th month and 8th year. CT slices were divided into six equal parts marking the distance between the femoral and tibial tunnels with the most distant part of the knee joint as L1, and with the entry point on the knee joint as L6. The tunnel length was measured in millimeters and perpendicularly to the tibial axis in the sagittal and coronal planes. Tunnel cross-sectional areas were also measured in mm2 using the same device on axial reconstructions. Clinical evaluations on the 8th year were performed with the IKDC, Tegner and Lysholm knee scoring systems and laxity in the patients was evaluated with the anterior drawer test. Posterolateral tunnel widening was analyzed with the repeated measures ANOVA technique whereas two-way mixed ANOVA was employed in evaluating the anteromedial tunnel widening. Three-way ANOVA was used in assessing the Biodex results and comparison of the scoring systems results were done with the t-test. Results: No difference was found between the groups in terms of IKDC, Lysholm and Tegner scores and anterior drawer test results at the 8th year follow-up (p>0.05). Points where significant amounts of tunnel widening were observed are shown in Table 1 . On evaluation of the anteromedial bundles alone, it was observed that double-tunnel reconstruction led to greater widening. No significant difference was found between the groups in terms of muscle strength in the 8th year assessments, however, there was a statistically significant difference between the preoperative and 6th month results (p<0.05). Patients in both groups had better results at the 8th year follow-up when compared to their preoperative and 6th month results. The results of our study confirmed significant amounts of widening at parts of the femoral tunnel close to the knee joint in patients treated with single-bundle or double-bundle ACL reconstruction. However, there is no difference between the groups in terms of clinical results and isometric muscle strengths in the long term. [Table: see text] Discussion: It has been suggested that the tunnel widening will lead to failure of the reconstruction. It is hypothesized that, in double-bundle reconstruction, the tunnels will widen more and finally coalesce, which in turn, will result in failure of the reconstruction. In our study, we found no evidence pointing out to a coalescence of the tunnels in the long term. We believe the greater widening in the anteromedial bundle in the double-tunnel surgery vs. the single-tunnel method is due to the smaller diameter of the graft and its greater mobility

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

2020 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Bunsei Goto
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Target Point ◽  
Single Bundle ◽  
Anterior Cruciate ◽  
Transportal Technique

AbstractThe purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms “anterior cruciate ligament reconstruction,” “anatomic or anatomical,” and “single bundle.” Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow–deep direction (32.3%) and in a high–low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.

Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

2017 ◽  
Vol 45 (10) ◽  
pp. 2418-2427 ◽  
Author(s):  
William M. Browning ◽  
Melissa A. Kluczynski ◽  
Christian Curatolo ◽  
John M. Marzo
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Hamstring Tendon ◽  
Significant Difference ◽  
Fixation Techniques ◽  
Suspensory Fixation ◽  
Aperture Fixation ◽  
Anterior Cruciate

Background: Hamstring grafts have become a popular choice for anterior cruciate ligament (ACL) reconstruction; however, the most effective means of fixation of these soft tissue grafts is unknown. Purpose: To determine whether suspensory or aperture fixation of hamstring tendon autografts provides better stability and clinical outcomes in ACL reconstruction. Study Design: Meta-analysis. Methods: A literature search of studies reporting single-bundle ACL reconstructions using 4-stranded hamstring tendon autografts with aperture or suspensory fixation with a minimum 24-month follow-up was conducted. Stability and clinical outcomes were compared for aperture versus suspensory fixation. Knee stability was measured with the Lachman or pivot-shift test or KT-1000 arthrometer side-to-side difference (SSD), and outcomes were determined with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores as well as graft failures. A random-effects model with a pooled estimate for the between-study variance was used to estimate proportions or means for each outcome and its corresponding 95% CI. Results: Forty-one studies were included, of which 20 utilized suspensory fixation techniques and 21 utilized aperture fixation techniques. A >3-mm SSD was seen more often in the aperture group than the suspensory group, which was statistically significant ( P < .0001), but there was no significant difference between groups for a >5-mm SSD ( P = .53). The aperture group demonstrated significantly more graft ruptures than did the suspensory group ( P = .03). There were no statistically significant differences in Lachman grade 0 ( P = .76), grade 1 ( P = .89), and grade 2 ( P = .55) or pivot-shift grade 0 ( P = .72), grade 1 ( P = .97), and grade 2 ( P = .28). There was no statistically significant difference in mean continuous IKDC ( P = .80), Tegner ( P = .34), or Lysholm ( P = .84) scores. Conclusion: This meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled hamstring tendon autograft in ACL reconstruction. There were no differences in IKDC, Lysholm, Lachman, and pivot-shift outcomes between suspensory and aperture fixation.

Sign in / Sign up

Export Citation Format

Share Document