scholarly journals Evaluation of a novel lower radiation computed tomography protocol for assessment of tunnel position post anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
varun vasudeva ◽  
Stephen Key ◽  
Alfred Phillips ◽  
Steve Kahane ◽  
Joseph Stevens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Radiation Dose ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Effective Radiation Dose ◽  
Tunnel Position ◽  
Anterior Cruciate ◽  
Conventional Ct

Abstract Background Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is <0.5mSv, which is significantly less than the 2mSv dose for a conventional CT protocol. The aim of this study was to assess the accuracy of the LDCT protocol for determining tunnel position. Methods Twenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed six weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, four weeks apart. Results There was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were >0.9 for all measurements. Conclusions The LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

scholarly journals Evaluation of a novel lower radiation computed tomography protocol for assessment of tunnel position post anterior cruciate ligament reconstruction 

2020 ◽  
Author(s):  
varun vasudeva ◽  
Stephen Key ◽  
Alfred Phillips ◽  
Steve Kahane ◽  
Joseph Stevens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Radiation Dose ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Effective Radiation Dose ◽  
Tunnel Position ◽  
Anterior Cruciate ◽  
Conventional Ct

Abstract Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is <0.5millisieverts (mSv), which is significantly less than the 2mSv dose for a conventional CT protocol. The aim of this study was to assess the accuracy of the LDCT protocol for determining tunnel position.Methods: Twenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed six weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, four weeks apart.Results: There was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were >0.9 for all measurements. Conclusions: The LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

Anteromedial Tibial Attachment in Single-Bundle Anterior Cruciate Ligament Reconstruction Can Represent Normal Kinematics in Computer Simulation

2022 ◽  
Author(s):  
Shinichiro Nakamura ◽  
Yoshihisa Tanaka ◽  
Shinichi Kuriyama ◽  
Kohei Nishitani ◽  
Mutsumi Watanabe ◽  
...  
Keyword(s):  
Computer Simulation ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Knee Kinematics ◽  
Axial Rotation ◽  
Single Bundle ◽  
Tunnel Position ◽  
Anterior Cruciate

AbstractTunnel position during anterior cruciate ligament (ACL) reconstruction is considered as an important factor to restore normal knee kinematics and to gain better clinical outcomes. It is still unknown where the optimal femoral and tibial tunnel position is located in single-bundle (SB) ACL reconstruction. The purposes of this study were to analyze the knee kinematics with various graft positions and to propose the optimal graft position during SB ACL reconstruction. A musculoskeletal computer simulation was used to analyze knee kinematics. Four attachments on the femoral side (anteromedial [AM], mid, posterolateral [PL], and over-the-top positions) and three attachments on the tibial side (AM, middle, and PL positions) were determined. The middle-bundle attachment was placed at the midpoint of the AM and PL bundle attachments for the femoral and tibial attachments. SB ACL reconstruction models were constructed to combine each of the four femoral attachments with each of three tibial attachments. Kinematic comparison was made among a double-bundle (DB) model and 12 SB reconstruction models during deep knee bend and stair descent activity. The tunnel position of the tibia had greater effect of knee kinematics than that of the femur. AM tibial attachment models showed similar medial and lateral anteroposterior positions to the DB model for both activities. Axial rotation in the AM tibial attachment models was similar to the DB model regardless of the femoral attachment, whereas greater maximum axial rotation was exhibited in the PL tibial attachment models, especially during stair descent activity. AM tibial attachment can represent normal knee kinematics, whereas the PL tibial attachment can induce residual rotational instability during high-demand activities. The AM tibial tunnel is recommended for SB ACL reconstruction.

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

Surgical techniques of anterior cruciate ligament reconstruction

2011 ◽  
Author(s):  
Julian Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Cruciate Ligament Reconstruction ◽  
Tunnel Position ◽  
Anterior Cruciate

♦ The principal indication for ACL reconstruction is instability, either existent or predicted♦ In general, it is crucial that the knee has settled and motion has been restored prior to surgery♦ Accurate tunnel position is the most important aspect of surgery

Comparison of Acorn and Fluted Reamers on Tibial Tunnel Outer Aperture Dimensions in Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Adam D. Gerrard ◽  
Chris M. Jump ◽  
Paul Sutton ◽  
Charalambos P. Charalambous
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Aperture Width ◽  
The Mean ◽  
Anterior Cruciate ◽  
Degree Deviation ◽  
Substantial Change

AbstractThe aim of this study was to determine if the type of reamer used in tibial tunnel creation during anterior cruciate ligament (ACL) reconstruction influences the dimensions of the tunnel's outer aperture. Tibial tunnels were created in tibial saw bones by reaming over a guidewire using an 8 mm acorn or fluted reamer in an antegrade manner. Reaming was aimed either in line with the guidewire, or with 10-degree inferior/superior deviation in relation to the wire. The shape and size of the outer aperture of the tibial tunnel were compared between the two reamers. When using the acorn reamer, a 10-degree deviation in relation to the guidewire resulted in minimal change in outer aperture length (mean 13.6 vs. 15.6 mm, p = 0.11) and width (11.6 vs. 11.1 mm, p = 0.51). However, when using the fluted reamer, although the aperture width showed no substantial change with reamer/guidewire deviation (11.4 vs. 11.2 mm, p = 0.71), the mean length almost doubled (14.7 vs. 28.1 mm, p = 0.002). The use of a fluted reamer when reaming the tibial tunnel creates a distal aperture which is inconsistently sized, larger, and of oblong shape compared with an acorn-shaped reamer. This should be taken in consideration when using a fluted reamer for creating the tibial tunnel in ACL reconstruction.

A Preclinical Model to Study the Influence of Graft Force on the Healing of the Anterior Cruciate Ligament Graft

2018 ◽  
Vol 32 (05) ◽  
pp. 441-447
Author(s):  
Richard Ma ◽  
Mark Stasiak ◽  
Xiang-Hua Deng ◽  
Scott Rodeo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Tunnel Position ◽  
Anterior Cruciate Ligament Graft ◽  
Acl Graft ◽  
Anterior Cruciate ◽  
Femoral Graft

AbstractThe purpose of this study is to establish a small animal anterior cruciate ligament (ACL) reconstruction research model where ACL graft force can be varied to create different graft force patterns with controlled knee motion. Cadaveric (n = 10) and in vivo (n = 10) rat knees underwent ACL resection followed by reconstruction using a soft tissue autograft. Five cadaveric and five in vivo knees received a nonisometric, high-force femoral graft tunnel position. Five cadaveric and five in vivo knees received a more isometric, low-force graft tunnel position. ACL graft force (N) was then recorded as the knee was ranged from extension to 90 degrees using a custom knee flexion device. Our results demonstrate that distinct ACL graft force patterns were generated for the high-force and low-force femoral graft tunnels. For high-force ACL grafts, ACL graft forces increased as the knee was flexed both in cadaveric and in vivo knees. At 90 degrees of knee flexion, high-force ACL grafts had significantly greater mean graft force when compared with baseline (cadaver: 7.76 ± 0.54 N at 90 degrees vs. 4.94 ± 0.14 N at 0 degree, p = 0.004; in vivo: 7.29 ± 0.42 N at 90 degrees vs. 4.74 ± 0.13 N at 0 degree, p = 0.007). In contrast, the graft forces for low-force ACL grafts did not change with knee flexion (cadaver: 4.94 ± 0.11 N at 90 degrees vs. 4.72 ± 0.14 N at 0 degree, p = 0.41; in vivo: 4.78 ± 0.26 N at 90 degrees vs. 4.77 ± 0.06 N at 0 degree, p = 1). Compared with nonisometric ACL grafts, the graft force for grafts placed in an isometric position had significantly lower ACL graft forces at 15, 30, 45, 60, 70, and 90 degrees in both cadaveric and in vivo knees. In conclusion, we have developed a novel ACL reconstruction model that can reproducibly produce two ACL graft force patterns. This model would permit further research on how ACL graft forces may affect subsequent graft healing, maturation, and function.

scholarly journals Radiographic analysis of the tibial tunnel position after anterior cruciate ligament reconstruction

2018 ◽  
Vol 71 (1-2) ◽  
pp. 15-20
Author(s):  
Vladimir Ristic ◽  
Nenad Ristic ◽  
Vladimir Harhaji ◽  
Mile Bjelobrk ◽  
Vukadin Milankov
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Operative Procedure ◽  
Cruciate Ligament Reconstruction ◽  
Tunnel Position ◽  
Tibial Tunnel Position ◽  
Anterior Cruciate

Introduction. The aim of the study was to analyze the tibial tunnel position after anterior cruciate ligament reconstruction. Material and Methods. The study included 830 patients who underwent this operative procedure. There were four times more male than female patients. The tibial tunnel placement was analyzed on frontal and lateral radiograph images of the knee joint. Results. The average frontal tibial index was 55% (35 - 68%), the average frontal tibial angle was 75 degrees (58 - 90), the sagittal tibial index was 30% (15 - 52%) and the sagittal tibial angle was 68 degrees (50 - 89). Conclusion. A significant deviation from these values may potentially lead to failure of the anterior cruciate ligament reconstruction.

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