Bone Tunnel Placement Determination Method for 3D Images and Its Evaluation for Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 16 (5) ◽  
pp. 491-498
Author(s):  
Kento Morita ◽  
Manabu Nii ◽  
Min-Sung Koh ◽  
Kaori Kashiwa ◽  
Hiroshi Nakayama ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
X Ray ◽  
Reconstruction Surgery ◽  
Quadrant Method ◽  
Knee Mri ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: Anterior cruciate ligament (ACL) injury causes knee instability which affects sports activity involving cutting and twisting motions. The ACL reconstruction surgery replaces the damaged ACL with artificial one which is fixed to the bone tunnels opened by the surgeon. The outcome of the ACL reconstruction is strongly related to the placement of the bone tunnels, therefore, the optimization of tunnel drilling technique is an important factor to obtain satisfactory surgical results. Aims: The quadrant method is used for the post-operative evaluation of the ACL reconstruction surgery, which evaluates the bone tunnel opening sites on the lateral 2D X-ray radiograph. Methods: For the purpose of applying the quadrant method to the pre-operative knee MRI, we have synthesized the pseudo lateral 2D X-ray radiograph from the patients' knee MRI. This paper proposes a computer-aided surgical planning system for the ACL reconstruction. The proposed system estimates appropriate bone tunnel opening sites on the pseudo lateral 2D X-ray radiograph synthesized from the pre-operative knee MRI. Results: In the experiment, the proposed method was applied to 98 subjects including subjects with osteoarthritis. The experimental results showed that the proposed method can estimate the bone tunnel opening sites accurately. The other experiment using 36 healthy patients showed that the proposed method is robust to the knee shape deformation caused by disease. Conclusion: It is verified that the proposed method can be applied to subjects with osteoarthritis.

scholarly journals Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction

2002 ◽  
Vol 82 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Matthew C Morrissey ◽  
Wendy I Drechsler ◽  
Dylan Morrissey ◽  
Philippa R Knight ◽  
Paul W Armstrong ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Resistance Training ◽  
Acl Reconstruction ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Early Period ◽  
Kinetic Chain ◽  
Reconstruction Surgery ◽  
Open Kinetic Chain ◽  
Anterior Cruciate

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

scholarly journals The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction

2018 ◽  
Vol 7 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Y. Sato ◽  
R. Akagi ◽  
Y. Akatsu ◽  
Y. Matsuura ◽  
S. Takahashi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Methods Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing. Results Histologically, both groups showed a mixture of direct and indirect healing patterns at four weeks, whereas only indirect healing patterns were observed in both groups at eight weeks. No significant histological differences were seen between the two groups at four and eight weeks in the roof zone (four weeks, S: mean 4.8 sd 1.7, T: mean 4.5 sd 0.5, p = 0.14; eight weeks, S: mean 5.8 sd 0.8, T: mean 4.8 sd 1.8, p = 0.88, Mann-Whitney U test) or side zone (four weeks, S: mean 5.0 sd 1.2, T: mean 4.8 sd 0.4, p = 0.43; eight weeks, S: mean 5.3 sd 0.8,T: mean 5.5 sd 0.8, p = 0.61, Mann-Whitney U test) . Similarly, no significant difference was seen in the maximum failure load between group S and group T at four (15.6 sd 9.0N and 13.1 sd 5.6N) or eight weeks (12.6 sd 3.6N and 17.1 sd 6.4N, respectively). Conclusion Regardless of bone tunnel configuration, tendon-bone healing after ACL reconstruction primarily occurred through indirect healing. No significant histological or mechanical differences were observed between adjustable and fixed-loop femoral cortical suspension methods. Cite this article: Y. Sato, R. Akagi, Y. Akatsu, Y. Matsuura, S. Takahashi, S. Yamaguchi, T. Enomoto, R. Nakagawa, H. Hoshi, T. Sasaki, S. Kimura, Y. Ogawa, A. Sadamasu, S. Ohtori, T. Sasho. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: An animal study. Bone Joint Res 2018;7:327–335. DOI: 10.1302/2046-3758.75.BJR-2017-0238.R2.

The Effect of Graft Pretensioning on Bone Tunnel Diameter and Bone Formation After Anterior Cruciate Ligament Reconstruction in a Rat Model: Evaluation With Micro–Computed Tomography

2017 ◽  
Vol 45 (6) ◽  
pp. 1349-1358 ◽  
Author(s):  
Jian-Chun Zong ◽  
Richard Ma ◽  
Hongsheng Wang ◽  
Guang-Ting Cong ◽  
Amir Lebaschi ◽  
...  
Keyword(s):  
Bone Formation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
New Bone Formation ◽  
Micro Computed Tomography ◽  
Load To Failure ◽  
Tunnel Diameter ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: Moderate graft pretensioning in anterior cruciate ligament (ACL) reconstruction is paramount to restore knee stability and normalize knee kinematics. However, little is known about the effect of graft pretensioning on graft-to-bone healing after ACL reconstruction. Hypothesis: Moderate graft pretensioning will improve bone formation within the bone tunnel after ACL reconstruction, resulting in superior load to failure. Study Design: Controlled laboratory study. Methods: 67 male Sprague-Dawley rats underwent unilateral ACL reconstruction with a flexor digitorum longus tendon autograft. The graft was subjected to pretensioning forces of 0 N, 5 N, or 10 N. Custom-made external fixators were used for knee immobilization postoperatively. Rats were euthanized for biomechanical load-to-failure testing (n = 45) and micro–computed tomography (μCT) examination (n = 22) at 3 and 6 weeks after surgery. Three regions of each femoral and tibial bone tunnel (aperture, middle, and tunnel exit) were chosen for measurement of tunnel diameter and new bone formation. Results: Biomechanical tests revealed significantly higher load-to-failure in the 5-N graft pretensioned group compared with the 0- and 10-N groups at 3 weeks (8.58 ± 2.67 N vs 3.96 ± 1.83 N and 4.46 ± 2.62 N, respectively) and 6 weeks (16.56 ± 3.50 N vs 10.82 ± 1.97 N and 7.35 ± 2.85 N, respectively) after surgery ( P < .05). The mean bone tunnel diameters at each of the 3 regions were significantly smaller in the 5-N group, at both the femoral and tibial tunnel sites, than in the 0- and 10-N groups ( P < .05). At 3 and 6 weeks postoperatively, the bone mineral density, bone volume fraction, and connectivity density around the aperture and middle regions of the tibial bone tunnels were all significantly higher in the 5-N group compared with the 0- and 10-N groups ( P < .05). In the aperture and middle regions of the femoral bone tunnels, pretensioning at either 5 or 10 N resulted in increased bone formation compared with the nonpretensioned group at 3 weeks postoperatively. No differences were found in bone formation between any of the 3 femoral tunnel regions at 6 weeks. Conclusion: Graft pretensioning can stimulate new bone formation and improve tendon-to-bone tunnel healing after ACL reconstruction. Clinical Relevance: Optimal graft pretensioning force in ACL reconstruction can improve bone tunnel healing. Further study is necessary to understand the mechanisms underlying the effect of graft pretensioning on healing at the bone-tunnel interface.

scholarly journals Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769360 ◽  
Author(s):  
Eric J. Wall ◽  
Paul J. Ghattas ◽  
Emily A. Eismann ◽  
Gregory D. Myer ◽  
Preston Carr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Reconstruction Technique ◽  
Skeletally Immature ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown. Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up. Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( P = .040) and the number of sports played ( P = .029). Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

scholarly journals Bone marrow stromal cells from a GDF5 origin produce zonal tendon-to-bone attachments following anterior cruciate ligament reconstruction

2019 ◽  
Author(s):  
Yusuke Hagiwara ◽  
Felix Dyrna ◽  
Andrew F Kuntz ◽  
Douglas J Adams ◽  
Nathaniel A Dyment
Keyword(s):  
Bone Marrow ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Host Cells ◽  
Biological Mechanisms ◽  
Anterior Cruciate ◽  
Bone Tunnels ◽  
Anterior Posterior

ABSTRACTFollowing anterior cruciate ligament (ACL) injury, the ligament is often reconstructed with a tendon graft passed through bone marrow tunnels. This procedure results in a staged repair response where cell death occurs in the tendon graft, the graft is repopulated by host cells outside the graft, and tendon-to-bone attachments form at the graft/bone interface. While this healing process is well appreciated, the biological mechanisms that regulate it including the cellular origin of the repair response is poorly understood. Embryonic progenitor cells expressing growth and differentiation factor 5 (GDF5) give rise to several mesenchymal tissues in the joint and epiphyses. Therefore, we hypothesized that cells from a GDF5 origin, even in the adult tissue, would give rise to cells that contribute to the stages of repair following ACL reconstruction. ACLs were reconstructed in Gdf5Cre;R26R-tdTomato lineage tracing mice to monitor the contribution of Gdf5Cre;tdTom+ cells to graft revitalization and examine the extent to which these cells are capable of creating mineralized attachments within the bone tunnels. Anterior-posterior drawer tests were used to establish the stability of the knee following the procedure and demonstrated 58% restoration in anterior-posterior stability. Following reconstruction, Gdf5Cre;tdTom+ cells within the bone marrow expanded by 135-fold compared to intact controls in response to the injury. These cells migrated to the tendon graft interface, repopulated regions of the graft, and initiated tendon-to-bone attachments. These cells continued to organize and mature the attachments yielding a zonal insertion site at 4 weeks with collagen fibers spanning across unmineralized and mineralized fibrocartilage and anchored to adjacent bone. The zonal attachment possessed organized tidemarks with concentrated alkaline phosphatase activity similar to normal tendon or ligament entheses. This study established that mesenchymal cells from a GDF5 origin contribute to the creation of zonal tendon-to-bone attachments within bone tunnels following ACL reconstruction. Future studies will target this cell population to modulate the repair response in order to better understand key biological mechanisms that regulate tendon-to-bone repair.

A Single Cycle Study of Screw Fixation in Anterior Cruciate Ligament Reconstruction

2008 ◽  
Author(s):  
M. Chizari ◽  
B. Wang ◽  
M. Snow
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Anatomical Reconstruction ◽  
Initial Stability ◽  
History Of ◽  
Post Traumatic ◽  
Anterior Cruciate

The natural history of Anterior Cruciate rupture is one of progressive deterioration of knee function, with the development of instability, meniscal tears and post traumatic osteoarthritis. The current surgical approach is for anatomical reconstruction using a biological tissue autograft. It is well understood that the initial stability is dependent on the strength of the fixation rather than the strength of the graft, until the graft becomes biologically incorporated in the bone tunnel. A study was carried out to better understand postoperative internal bone stresses in anterior cruciate ligament (ACL) reconstruction surgery. The mechanical aspects of an interface screw fixation were examined both experimentally and numerically, with the aim to minimize deleterious effects in ACL reconstruction. The tibial cortical/cancellous bony tunnel and the stress pattern resulting from the screw fixation in the tunnel are investigated.

A Simple Method to Reduce the Incidence of Cyclops Lesion after Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Keita Nagira ◽  
Makoto Enokida ◽  
Ikuta Hayashi ◽  
Koji Ishida ◽  
Haruhisa Kanaya ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Cruciate Ligament Reconstruction ◽  
Cyclops Lesion ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Bone Tunnels

AbstractThe purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel debridement was not performed. Postoperative MRI was performed to evaluate the presence of CL and the following three criteria: (1) the intercondylar site of CL (grade 1–3), depending on its anterior extent along the femoral condyle; (2) posterior bowing of the ACL graft; and (3) the positional relationship between the frontmost fiber of ACL graft and Blumensaat's line. If CL caused loss of extension or pain or discomfort during knee extension, it was defined as symptomatic CL (SCL). CL was detected in 8 cases (21.1%) in Group A and 26 cases (46.4%) in Group B. The prevalence of CL was significantly lower in Group A than in Group B (p = 0.010), and the risk ratio of CL was 0.31 (95% confidence interval: 0.12–0.79). Furthermore, 10 patients in Group B had SCL, compared with none in Group A (p = 0.004). In Group A, the intercondylar site of CL was grade 1 in all cases, while in Group B, the CL grades were 1 (n = 17), 2 (n = 7), 3 (n = 2) (p = 0.008). There were no cases of posterior bowing of the ACL in Group A, but six cases in Group B (p = 0.023). Debridement in and around the bone tunnel is a simple and effective method of preventing CL and SCL after ACLR. The level of evidence for the study is 3.

scholarly journals Comparison of Ultrasound-Guided Femoral and Infrapatellar Nerve Block Effects after Anterior Cruciate Ligament Repair Surgery

2020 ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Acl Reconstruction ◽  
Nerve Block ◽  
Muscle Force ◽  
Cruciate Ligament ◽  
Ultrasound Guided ◽  
Reconstruction Surgery ◽  
The Mean ◽  
Anterior Cruciate

Background: There are various protocols for pain management after anterior cruciate ligament (ACL) reconstruction surgery. Objective: This study aimed to compare two blocking protocols, including femoral nerve block (FNB) and infrapatellar nerve block (IPNB) in terms of pain severity, patient satisfaction, and muscle force preservation. Materials and Methods: This single-blind clinical trial study investigated the patients who underwent elective knee arthroscopic ACL surgery randomly either by ultrasound-guided FNB or IPNB. Subsequently, the patients were evaluated 1, 3, 6, 12, and 24 h following NB for pain severity, patient satisfaction level, and muscle force. Results: The pain score (both at rest and in flexion) was significantly lower in the first three h after the intervention in the FNB group. Moreover, the mean score of the patients’ satisfaction in the first hours was significantly higher in the FNB group after the procedure. Additionally, the IPNB group obtained a significantly faster mean time required for the first dose of opioid request. The mean dose of used opioids over 24 h was significantly lower in the FNB group. There was a significant difference between the groups in terms of the muscle strength score within 24 h; moreover, the FNB group obtained a significantly greater delay in muscle recovery. Conclusion: The FNB is associated with greater pain relief and satisfaction in patients who underwent arthroscopic ACL reconstruction surgery, compared to the IFNB technique. However, a further delay in the recovery of quadriceps muscle force is evident in the FNB group.

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