Tibial tunnel widening associated with anterior cruciate ligament reconstruction using autogenous hamstrings: A comparison between antero-medial portal and transtibial techniques

Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study

Background:

Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but serious complication.

Purpose:

To assess the effect of joint infection on the graft, cartilage, and bone tunnel using magnetic resonance imaging (MRI) after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendons.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This retrospective matched cohort study included 26 patients who underwent arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at the authors’ institute between January 2002 and December 2017 and developed postoperative joint infection. These patients were matched 1:3 to patients who did not sustain joint infection after ACL reconstruction (control group). MRI scans were collected at the time of follow-up. The following parameters were evaluated: graft signal-to-noise quotient (SNQ); graft signal intensity at the bone-graft interface and within the knee joint; bone tunnel enlargement at the tunnel aperture, midsection, and exit of the tibial and femoral tunnels; and cartilage integrity.

Results:

The average follow-up time was 47.8 months in the infection group and 48.5 months in the control group. Compared with the control group, the infection group had a significantly higher SNQ (20.01 ± 12.08 vs 7.61 ± 6.70; P = .014) as well as a higher signal intensity at the bone-graft interface (P = .037) and higher Howell grade (P = .031). The mean enlargement at the femoral tunnel aperture was 31.20% ± 26.76% in the infection group and 19.22% ± 20.10% in the control group (P = .037). The articular cartilage of the patellofemoral and lateral femorotibial joints showed more degenerative change in the infection group.

Conclusion:

Study findings indicated that graft ligamentization and incorporation graft maturity were inferior in patients who experienced a joint infection after ACL reconstruction compared with patients who did not.

Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes

PURPOSE

The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture.

MATERIALS AND METHODS

It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts' anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated.

RESULTS

The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes.

CONCLUSIONS

Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.