scholarly journals Bone tunnel enlargement after the reconstruction of anterior cruciate ligament using bone-tendon-bone graft

2018 ◽  
Vol 75 (7) ◽  
pp. 682-690
Author(s):  
Srdjan Ninkovic ◽  
Vladimir Harhaji ◽  
Predrag Rasovic ◽  
Nemanja Gvozdenovic ◽  
Mirko Obradovic
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Second Phase ◽  
Arthroscopic Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background/Aim. Bone-tendon-bone (BTB) graft is one of the strongest biological grafts and it provides a strong initial fixation with the application of interference screws making possible the primary bone healing and bone integration of the graft on the place of fixation during arthroscopic reconstruction of the arterior cruciate ligament of the knee. The aim of our research was to determine if BTB graft from which, throughout the surgical treatment, soft tissue and periosteum are removed, leads to the reduction of the enlargement in the femoral and tibial bone after the arthroscopic reconstruction of the anterior cruciate ligament. Methods. The first phase consisted of bio-mechanical study on 12 pairs of cadaveric BTB grafts. The testing was performed on the mechanical testing machine. The second phase involved clinical testing. The first group consisted of 40 patients treated with the classical BTB autograft. The second group consisted of 56 patients who had two thirds of the bony parts of the bone-tendon-bone autografts of the soft tissue and periosteum removed. We measured the distance between the edge of the sclerotic tunnel on the tibial and femoral bone in three different points: proximal (F1;T1), middle (F2;T2) and the lower part (F3;T3). Results. The experimental part of the study showed no statistically significant difference in graft breakout force expressed in N/mm2 between classically treated BTB graft and graft with a partially removed soft tissue and periosteum. By comparing the expansion of tunnels in all segments in both bone tunnels between study groups, statistically significantly lower enlargement was measured in the group with BTB grafts with partially removed soft tissues and periosteum (p < 0.05). Conclusion. The use of BTB grafts with partially removed soft tissues and periosteum provides less bone tunnel expansion as compared to classically treated grafts of the anterior cruciate tendon.

A Simple Technique to Prevent Early or Late EndoButton Deployment in Anterior Cruciate Ligament Reconstructions: A Technical Note

2017 ◽  
Vol 31 (01) ◽  
pp. 075-077
Author(s):  
Rodrigo Salim ◽  
Mauricio Kfuri ◽  
Fabricio Fogagnolo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Simple Technique ◽  
Cruciate Ligament ◽  
Technical Note ◽  
Arthroscopic Reconstruction ◽  
Arthroscopic Technique ◽  
Frequent Use ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Bone Tunnels

AbstractThe use of suspensory graft fixation methods in arthroscopic reconstruction of the anterior cruciate ligament has become increasingly popular with the more frequent use of tendon grafts and anatomical techniques involving the creation of bone tunnels. An important technical step to ensure adequate fixation of the graft when using EndoButton-type implants, particularly in the femur, involves flipping the EndoButton plate at the correct length to avoid performing this maneuver before the appropriate time or leaving soft tissue between the plate and lateral cortex of the femur. In the present study, we describe a simple arthroscopic technique for indicating the correct time to flip/deploy the EndoButton plate.

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 The value of the sagittal-oblique MRI technique for injuries of the anterior cruciate ligament in the knee

2013 ◽  
Vol 47 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Dragoslav Nenezić ◽  
Igor Kocijancic
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Partial Rupture ◽  
Complete Rupture ◽  
Scan Time ◽  
Lower Accuracy ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Background. Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging versus flexion MR technique of ACL imaging and, versus ACL imaging obtained with standard MR protocol of the knee. Patients and methods. In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. Results. Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittaloblique technique were more sensitive (p<0.001) than presentation using standard MR protocol. There was no statistically significant difference between MRI detection of the ruptured ACL between additional techniques (p> 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p<0.001). Conclusions. Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient’s ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient’s knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears.

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.

A Comparison of Ligament Tensions Between Intra- and Extra-Articular Measurement in Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 19 (6) ◽  
pp. 778-784 ◽  
Author(s):  
Shogo Kawaguchi ◽  
◽  
Kouki Nagamune ◽  
Yuichiro Nishizawa ◽  
Shinya Oka ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Cadaveric Study ◽  
P Value ◽  
Significant Difference ◽  
Ligament Tension ◽  
Anterior Cruciate ◽  
Sensor Accuracy

Anterior cruciate ligament (ACL) reconstruction is one of the treatments of ACL injuries. In the surgery, the reconstructed ligament should be properly tensioned to provide a normal ligament behavior. However, the ligament tension has been measured with an extra-articular technique in past studies, while the intra-articular ligament tension is still unknown. The purpose of this study is to compare the ligament tensions between intra- and extra-articular measurements in the ACL reconstruction. Intra-articular measurement employs a micro-force sensor designed with a width and thickness same as those of the reconstructed ligament. This study performed two experiments (i.e., sensor accuracy and cadaveric study). In the sensor accuracy experiment, the accuracy of the sensor was about 3% until an applied force of 100 N. In the cadaveric study, the results of the intra- and extra-articular measurement tensions were 13.6±3.9 N and 18.7±1.3 N (n= 6), respectively. The significant difference in student t-test (p-value was 0.026) between the intra- and extra- articular measurements was observed. The bending angle and friction between the graft and bone tunnel, and the shape of the intra-articular edge of tibial bone tunnel affected the intra-articular measurement in ACL reconstruction.

The Role of Magnetic Resonance Imaging for Diagnosing Soft Tissue Lesions Associated with Anterior Cruciate Ligament Injuries

2018 ◽  
Vol 69 (9) ◽  
pp. 2498-2500
Author(s):  
Bogdan Sendrea ◽  
Antoine Edu ◽  
George Viscopoleanu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Traumatic Event ◽  
Cruciate Ligament ◽  
Soft Tissue Injuries ◽  
Resonance Imaging ◽  
Soft Tissue Lesions ◽  
Anterior Cruciate

Magnetic resonance imaging has become the gold standard for soft tissue lesions evaluation especially after a traumatic event where there is need for diagnostic confirmation. The objective of the current paper was to evaluate the ability of magnetic resonance imaging in diagnosing soft tissue lesions in patients who underwent anterior cruciate ligament reconstruction compared with arthroscopic findings. Through the ability to diagnose soft tissue injuries, particularly meniscal lesions, magnetic resonance imaging should be considered as fundamental in guiding therapeutic management in patients with anterior cruciate ligament lesions.

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