BONE TUNNEL ENLARGEMENT WITH NON-METALLIC INTERFERENCE SCREWS IN ACL RECONSTRUCTION

ABSTRACT Objective: To compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction. Methods: Three groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups. Results: Mean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference. Conclusion: Bone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.

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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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Biomechanical Modeling of a Bone Tunnel Enlargement Post ACL Reconstruction

10.1101/2020.09.03.281915 ◽

2020 ◽

Author(s):

Amirhossein Borjali ◽

Mahdi Mohseni ◽

Mahmoud Chizari

Keyword(s):

Acl Reconstruction ◽

Tibial Tunnel ◽

Interference Screw ◽

Bone Tunnel ◽

Tunnel Enlargement ◽

Tunnel Wall ◽

Fixation Failure ◽

Screw Insertion ◽

Bone Tunnel Enlargement

AbstractBackgroundBone tunnel enlargement is considered as a potential problem following ACL reconstruction and can cause a fixation failure and complicate its revision surgery. This study evaluates post tibial tunnel expansion in ACL reconstruction using an interference screw.MethodsA series of in-vitro experimental tests on animal bone and tissues were used to simulate post ACL reconstruction. The study believes an unbalanced lateral force can cause a local enlargement on the contact zone inside the tunnel. Grayscale X-ray images were used to assess the screw alignment inside the tunnel.ResultsThey showed a slight misalignment between the screw and the tunnel axis as the tendon strands moved along the side of the tunnel, and the screw had partial contact with the tendon and bone along the tunnel. According to the results, increased stress in the tunnel wall causes tunnel enlargement. Although the tunnel created away from the tibial central axis produced a higher strength, it results in higher stress on the wall of the tunnel which can increase the risk of tunnel expansion.ConclusionsThe current study believes the use of an unguided interference screw insertion potentially increases risks of the misaligned fixation and cause a tunnel enlargement. This risk may be controlled by restricting the post-operative rehabilitation.

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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

The Journal of Knee Surgery ◽

10.1055/s-0040-1710376 ◽

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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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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Calcium phosphate-hybridised tendon graft to reduce bone-tunnel enlargement after ACL reconstruction in goats

The Knee ◽

10.1016/j.knee.2011.03.008 ◽

2012 ◽

Vol 19 (4) ◽

pp. 455-460 ◽

Cited By ~ 13

Author(s):

Hirotaka Mutsuzaki ◽

Masataka Sakane ◽

Hiromi Nakajima ◽

Naoyuki Ochiai

Keyword(s):

Calcium Phosphate ◽

Acl Reconstruction ◽

Tendon Graft ◽

Bone Tunnel ◽

Tunnel Enlargement ◽

Bone Tunnel Enlargement

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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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Paper 4: Bone Tunnel Enlargement Following ACL Reconstruction. Influence of Compaction Drilling versus Bulby Drilling. A Prospective Randomised Study

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2012.05.291 ◽

2012 ◽

Vol 28 (8) ◽

pp. e74-e75

Keyword(s):

Acl Reconstruction ◽

Bone Tunnel ◽

Tunnel Enlargement ◽

Randomised Study ◽

Bone Tunnel Enlargement ◽

Prospective Randomised Study

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Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-l-lactic acid/hydroxyapatite bioabsorbable screws

The Knee ◽

10.1016/j.knee.2005.09.002 ◽

2006 ◽

Vol 13 (2) ◽

pp. 127-131 ◽

Cited By ~ 48

Author(s):

James Robinson ◽

Chris Huber ◽

Paul Jaraj ◽

Philippe Colombet ◽

Michel Allard ◽

...

Keyword(s):

Lactic Acid ◽

Acl Reconstruction ◽

Bone Tunnel ◽

Tunnel Enlargement ◽

Bone Tunnel Enlargement ◽

Bioabsorbable Screws

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Biomechanics of a Less Invasive Procedure for Reconstruction of the Ulnar Collateral Ligament of the Elbow

The American Journal of Sports Medicine ◽

10.1177/03635465980260050401 ◽

1998 ◽

Vol 26 (5) ◽

pp. 620-624 ◽

Cited By ~ 72

Author(s):

Keith S. Hechtman ◽

Evert W. Tjin-A-Tsoi ◽

John E. Zvijac ◽

John W. Uribe ◽

Loren L. Latta

Keyword(s):

Invasive Procedure ◽

Ulnar Collateral Ligament ◽

Bone Tunnel ◽

Peak Strain ◽

Collateral Ligament ◽

Bone Anchor ◽

Reconstruction Methods ◽

Significant Difference ◽

The Mean ◽

Bone Tunnels

A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the range of motion. Toward extension, the mean peak strain in the anterior band was tight for the normal and bone anchor groups, but lax in the bone tunnel group. Toward extension, the mean peak strain in the posterior band was lax in all elbows. Toward flexion, the strain in the anterior band was lax in the normal and bone anchor groups, but tight in the bone tunnel group. The mean of the peak strains for the posterior band toward flexion was tight for all elbows. Mean valgus load strength of normal elbows was 22.7 9.0 N m. The bone tunnel and bone anchor mean strengths were 76.3% and 63.5%, respectively, of normal elbow strength. We concluded that the bone anchor reproduced the normal anatomy and mechanical function of the ulnar collateral ligament more closely than the bone tunnel, and that both reconstruction methods were significantly weaker than the normal ulnar collateral ligament. However, we found no significant difference in reconstruction strength between bone anchor and bone tunnel.

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