scholarly journals Changing the Diameter of the Bone Tunnel Is More Effective Than Changing the Tunnel Shape for Restoring Joint Functionality After ACL Reconstruction

2020 ◽  
Vol 8 ◽  
Author(s):  
Huizhi Wang ◽  
Min Zhang ◽  
Cheng-Kung Cheng
Keyword(s):  
Cruciate Ligament ◽  
Joint Kinematics ◽  
Bone Tunnel ◽  
Combined Loading ◽  
Circular Tunnel ◽  
Tibial Cartilage ◽  
Anterior Tibial ◽  
Joint Biomechanics ◽  
Tunnel Diameter ◽  
Anterior Cruciate

The clinical implications of changing the shape of the bone tunnel for Anterior cruciate ligament reconstruction (ACLR) is controversial and few studies have reported on the long-term prevalence for osteoarthritis. As such, this study aims to evaluate the effect of tunnel shape on joint biomechanics. Finite element models of an ACLR were constructed with different shapes (circular, oval, rounded rectangular, rectangular, and gourd-shaped) and diameters (7.5, 8.5, and 9.5 mm) for the bone tunnel. A combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment and 6.9 Nm valgus tibial moment was applied at a joint flexion angle of 20°. Joint kinematics and the strain energy density (SED) on the articular cartilage were compared among the different groups. The results showed that conventional ACLR (circular tunnel) lead to an increase in joint kinematics over the intact joint, a lower ligament force and a higher SED on the lateral tibial cartilage. ACLR using the other tunnel shapes resulted in even greater joint kinematics, lower graft force and greater SED on the lateral tibial cartilage. Increasing the tunnel diameter better restored joint kinematics, graft force and articular SED, bringing these values closer to those from the intact knee. In conclusion, increasing the tunnel diameter may be more effective than changing the tunnel shape for restoring joint functionality after ACLR.

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 Influence of Graft Bending Angle on Graft Maturation, the Femoral Tunnel, and Functional Outcomes by 12 Months After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988266
Author(s):  
Hong Li ◽  
Shaohua Liu ◽  
Yaying Sun ◽  
Hongyun Li ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Bending Angle ◽  
Cruciate Ligament Reconstruction ◽  
Functional Scores ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Background: The graft bending angle (GBA), the angle between the femoral bone tunnel and the line connecting the femoral and tibial tunnel apertures, has been proven to influence stress within the graft and could be an important factor in graft healing within the joint and bone tunnel. However, the influence of the GBA on functional outcomes, particularly on return to sports (RTS), is rarely reported. Purpose/Hypothesis: The purpose of this study was to investigate the influence of the GBA on graft maturation, the femoral tunnel, and functional outcomes at 12 months after anterior cruciate ligament reconstruction (ACLR). We hypothesized that a greater GBA might be related to bone tunnel widening, poor graft healing, and inferior functional outcomes after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 43 consecutive patients who underwent unilateral ACLR with hamstring tendon autografts participated in this study. Their knees were evaluated using functional scores (International Knee Documentation Committee [IKDC] score, Lysholm knee activity score, Tegner activity scale, RTS) and the anterior tibial translation side-to-side difference (ATTD), as measured using a KT-1000 arthrometer and 3.0-T magnetic resonance imaging (MRI), at 12 months after surgery. Based on MRI, the signal/noise quotient (SNQ) of the graft, the GBA, and the femoral tunnel diameter were measured. Results: The mean GBA was 56° (range, 41°-69°). The GBA had a significant positive correlation with the SNQ (rho, 0.45; P = .003) and bone tunnel diameter (rho, 0.35; P = .02), but it had no significant correlation with any functional scores. Patients were divided into 3 groups based on GBA values: low GBA (LGBA; 40° < GBA ≤ 50°), middle GBA (MGBA; 50° < GBA ≤ 60°), and high GBA (HGBA; 60° < GBA ≤ 70°). The HGBA group had a significantly higher mean SNQ than both the LGBA ( P = .01) and MGBA groups ( P = .02). It also had a greater mean tunnel diameter than the LGBA group ( P = .04). There was no significant difference in IKDC scores, Lysholm scores, ATTD, Tegner scores, or rates of RTS among groups. Conclusion: The GBA did not affect functional outcomes at 12 months after ACLR, although it affected the SNQ of the graft and the femoral tunnel diameter.

scholarly journals Can the Body Slope of Interference Screw Affect Initial Stability of Reconstructed Anterior Cruciate Ligament?: In-vitro Investigation

2021 ◽  
Author(s):  
Nazanin Daneshvarhashjin ◽  
Mahmoud Chizari ◽  
SM Javad Mortazavi ◽  
Gholamreza Rouhi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Interference Screws ◽  
Bone Screw ◽  
Initial Stability ◽  
In Vitro Investigation ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Background Superior biomechanical performance of tapered interference screws, in regard to reconstruction of anterior cruciate ligament (ACL), compared with non-tapered screws, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is not studied yet. Thus, the main goal of this study was to investigate the effects of interference screw's body slope on the initial stability of the reconstructed ACL. Methods Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screw were designed and fabricated. The diameters of both screws were considered to be equal to bone tunnel diameter in one third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct's stiffness and graft laxity in each cycle, and through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, performance of the fabricated interference screws were compared with each other. Results HSTIS, compared to LSTIS, provides a greater graft-bone-screw construct stiffness, and a lower graft laxity. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in HSTIS group were the major types of grafts' failure. ConclusionHSTIS compared to LSTIS, by causing less damage in graft's fibers; reducing graft laxity; and increasing fixation stability, better replicates the intact ACL's behavior.

scholarly journals Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nazanin Daneshvarhashjin ◽  
Mahmoud Chizari ◽  
Javad Mortazavi ◽  
Gholamreza Rouhi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Reconstruction Process ◽  
Interference Screws ◽  
Bone Screw ◽  
Initial Stability ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Background Superior biomechanical performance of tapered interference screws, compared with non-tapered screws, with reference to the anterior cruciate ligament (ACL) reconstruction process, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is poorly understood. Thus, the main goal of this study was to investigate the effect of the interference screw’s body slope on the initial stability of the reconstructed ACL. Methods Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screws were designed and fabricated. The diameters of both screws were equal to bone tunnel diameter in one-third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct’s stiffness and graft laxity in each cycle, also through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, the performance of the fabricated interference screws was compared with each other. Results HSTIS provides a greater graft-bone-screw construct stiffness, and a lower graft laxity, compared to LSTIS. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in the HSTIS group were the major types of grafts’ failure. Conclusions HSTIS better replicates the intact ACL’s behavior, compared to LSTIS, by causing less damage in graft’s fibers; reducing graft laxity; and increasing fixation stability. Nonetheless, finding the optimal slope remains as an unknown and can be the subject of future studies.

scholarly journals The effect of autologous bone block and bioabsorbable screw in enlargement of bone tunnel in reconstruction of anterior cruciate ligament

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0009
Author(s):  
Süleyman Bülent Bektaşer ◽  
Durmuş Ali Öçgüder ◽  
İbrahim Bozkurt ◽  
Enes Uluyardımcı ◽  
Muhammed Nadir Yalçın
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Bone Block ◽  
Tibial Fixation ◽  
Lachman Test ◽  
Bioabsorbable Screw ◽  
Tunnel Diameter ◽  
Autologous Bone ◽  
Anterior Cruciate

Purpose: After reconstruction of Anterior Cruciate Ligament (ACL), enlargement of bone tunnel is affected in different rates depending on graft fixation techniques. In this work, we searched the difference of tunnel enlargement between tibial fixation using autologous tibia bone block and tibial fixation using bioscrew. Method: In this prospective work, 48 patients are taken assessment, who were operated because of ACL rupture, from January 2012 to October 2013. The patients are operated by one surgeon and Hamstring tendon is used as graft (semitendinosus folded twice and gracilic tendons). Tibial fixation of 22 patients is ensured by autologous bone block and spiked washers. Tibial fixation of 26 patients is ensured by absorbable bioscrew and “U” nail. In both patient groups, femoral determination is made using sling implant. Between 2 and 2,5 postoperative years, the patients, visualized using computarized tomography, are assessed in enlargement of tibial tunnel diameter. Under clinical circumstances, patients are assessed using Lachman Test and Tegner Activity Score. Results: Sagittal and coronal Computarized Tomography vision of 48 patients, tunnel diameters are measured from 2 cm distal of articular surface, then the percentage of bone enlargement is counted. The tunnel diameter enlargement of 22 patients, to whom autologous bone block is used is %-0,18 in average, but the enlargement of 26 patients, to whom bioabsorbable screw is used, is 9,98 in average. When we compare the two group of tests, it is found that this test is statistically senseful in enlargement of tunnel diameter(p<0,001). When we compare the patients, the enlargement of tunnel gets lesser when we use bone block. According to Lachman test and Tegner Activity Score, it is not found any meaningful difference between two groups. Conclusions: After two years, in comparison with the patients used bioabsorbable screw, the patients, used autologous bone block, encountered lesser bone loss. This method gives a couple of benefits; lesser bone loss lesser enlargement of tunnel diameter, easier surgery revision(although there is no difference clinically), furthermore, it makes the surgery easier because it eliminates one stage of the operation. Besides, the usage of autologous bone block provides meaningful decrease in costs and this is an important advantage.

scholarly journals Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199806
Author(s):  
Michèle N.J. Keizer ◽  
Egbert Otten ◽  
Chantal M.I. Beijersbergen ◽  
Reinoud W. Brouwer ◽  
Juha M. Hijmans
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Return To Sports ◽  
Beighton Score ◽  
Positive Correlation ◽  
Anterior Tibial ◽  
Flexion Moment ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers. Purpose/Hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers. Study Design: Controlled laboratory study. Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained. Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing. Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment. Clinical Relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.

Evaluation of Tibial Tunnel Location with the Femoral Tunnel Created Behind the Resident's Ridge in Transtibial Anterior Cruciate Ligament Reconstruction

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.

scholarly journals Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 419
Author(s):  
Chien-Kuo Wang ◽  
Liang-Ching Lin ◽  
Yung-Nien Sun ◽  
Cheng-Shih Lai ◽  
Chia-Hui Chen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Computer Assisted ◽  
Time Interval ◽  
Stress Radiography ◽  
Factors Affecting ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation

We sought to design a computer-assisted system measuring the anterior tibial translation in stress radiography, evaluate its diagnostic performance for an anterior cruciate ligament (ACL) tear, and assess factors affecting the diagnostic accuracy. Retrospective research for patients with both knee stress radiography and magnetic resonance imaging (MRI) at our institution was performed. A complete ACL rupture was confirmed on an MRI. The anterior tibial translations with four different methods were measured in 249 patients by the designed algorithm. The diagnostic accuracy of each method in patients with all successful measurements was evaluated. Univariate logistic regression analysis for factors affecting diagnostic accuracy of method four was performed. In the inclusive 249 patients, 177 patients (129 with completely torn ACLs) were available for analysis. Mean anterior tibial translations were significantly increased in the patients with a completely torn ACL by all four methods, with diagnostic accuracies ranging from 66.7% to 75.1%. The diagnostic accuracy of method four was negatively associated with the time interval between stress radiography and MRI as well as force-joint distance on stress view, and not significantly associated with age, gender, flexion angle, intercondylar distance, and force-joint angle. A computer-assisted system measuring the anterior tibial translation in stress radiography showed acceptable diagnostic performance of complete ACL injury. A shorter time interval between stress radiography and MRI as well as shorter force-joint distance were associated with higher diagnostic accuracy.

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