1
|
Li X, Li H, Su J, Ding R. Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:380. [PMID: 38745214 PMCID: PMC11092199 DOI: 10.1186/s12891-024-07464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Enlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel. METHODS Forty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score. RESULTS After a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05). CONCLUSION ACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.
Collapse
Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Jixian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
| |
Collapse
|
2
|
McMellen CJ, Sinkler MA, Calcei JG, Hobson TE, Karns MR, Voos JE. Management of Bone Loss and Tunnel Widening in Revision ACL Reconstruction. J Bone Joint Surg Am 2023; 105:1458-1471. [PMID: 37506198 DOI: 10.2106/jbjs.22.01321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
➤ Both mechanical and biological factors can contribute to bone loss and tunnel widening following primary anterior cruciate ligament (ACL) reconstruction.➤ Revision ACL surgery success is dependent on graft position, fixation, and biological incorporation.➤ Both 1-stage and 2-stage revision ACL reconstructions can be successful in correctly indicated patients.➤ Potential future solutions may involve the incorporation of biological agents to enhance revision ACL surgery, including the use of bone marrow aspirate concentrate, platelet-rich plasma, and bone morphogenetic protein-2.
Collapse
Affiliation(s)
- Christopher J McMellen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Taylor E Hobson
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Michael R Karns
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| |
Collapse
|
3
|
Kurihara S, Yanagisawa S, Takahashi T, Hagiwara K, Hatayama K, Takase R, Kimura M, Chikuda H. Increased Bone Plug Depth From the Joint Increases Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft With Suspensory Femoral Fixation. Arthrosc Sports Med Rehabil 2023; 5:100755. [PMID: 37520501 PMCID: PMC10382878 DOI: 10.1016/j.asmr.2023.100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/29/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To determine a safe bone plug depth fixation zone based on early tunnel enlargement rates in anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft with suspensory femoral fixation. Methods Patients who had undergone rectangular tunnel ACL reconstruction using BPTB autograft with suspensory femoral fixation were retrospectively identified. Femoral and tibial tunnel aperture areas were measured on computed tomography 2 weeks and 6 months after surgery to calculate rates of femoral and tibial tunnel enlargement (FTE and TTE), respectively. Femoral bone plug depth (FBPD) and tibial bone plug depth (TBPD) were defined as the distance of the tip of the plug from the respective joint lines. Optimal FBPD and TBPD cutoff values were calculated for the following rates of FTE and TTE, respectively: 0%, 15%, 30%, and 50%. Results Sixty-four patients (19 females, 45 males; mean age, 29.5 ± 12.3 years) were included in the study. The femoral and tibial tunnel apertures significantly enlarged over time. FBPD (P < .001; r = 0.607) and TBPD (P = .013; r = 0.308) were positively correlated with FTE and TTE, respectively. The optimal FBPD cutoff value was 2.8 mm for FTE rates of 0% and 15%, 3.6 mm for 30%, and 6.0 mm for 50%. The optimal TBPD cutoff value was 1.48 mm for a 0% TTE rate and 5.1 mm for those higher. The cutoff value specificities were lower for the tibial tunnel than the femoral tunnel for each tunnel enlargement rate. Conclusion Early tunnel enlargement and bone plug depth were significantly correlated in bone the femoral and tibial tunnels. The degree of correlation was higher in the femoral tunnel. To minimize bone tunnel enlargement, the distal end of the femoral bone plug should be placed less than 2.8 mm from the tunnel aperture. Level of Evidence Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Shingo Kurihara
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Shinya Yanagisawa
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimokoyama, Japan
| | - Keiichi Hagiwara
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Gunma, Japan
| | - Ryota Takase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masashi Kimura
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
4
|
Lee SS, Kim IS, Shin TS, Lee J, Lee DH. Femoral Tunnel Position Affects Postoperative Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft. J Clin Med 2023; 12:jcm12051966. [PMID: 36902753 PMCID: PMC10004624 DOI: 10.3390/jcm12051966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October 2017. TW was calculated as the difference in tunnel widths between the immediate and 2-year postoperative measurements. The risk factors for TW, including demographic data, concomitant meniscal injury, hip-knee-ankle angle, tibial slope, femoral and tibial tunnel position (quadrant method), and length of both tunnels, were investigated. The patients were divided twice into two groups depending on whether the femoral or tibial TW was over or less than 3 mm. Pre- and 2-year follow-up outcomes, including the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and side-to-side difference (STSD) of anterior translation on stress radiographs, were compared between TW ≥ 3 mm and TW < 3 mm. The femoral tunnel position depth (shallow femoral tunnel position) was significantly correlated with femoral TW (adjusted R2 = 0.134). The femoral TW ≥ 3 mm group showed greater STSD of anterior translation than the femoral TW < 3 mm group. The shallow position of the femoral tunnel was correlated with the femoral TW after ACL reconstruction using a tibialis anterior allograft. A femoral TW ≥ 3 mm showed inferior postoperative knee anterior stability.
Collapse
Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi 10380, Republic of Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jeounghun Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-3509
| |
Collapse
|
5
|
Kimura M, Nakase J, Asai K, Yoshimizu R, Kanayama T, Tsuchiya H. Tibial graft fixation methods and bone tunnel enlargement: A comparison between the TensionLoc implant system and the double-spike plate. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 28:31-37. [PMID: 35465464 PMCID: PMC9019697 DOI: 10.1016/j.asmart.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background/objective TensionLoc (Arthrex, Naples, Florida, USA), a tibial graft fixation system for anterior cruciate ligament (ACL) reconstruction, is expected to apply the preoperatively determined level of graft tension and allow setting of lower initial tension. Considering its mechanism, we hypothesised that TensionLoc would prevent postoperative bone tunnel enlargement (TE) through fixation with lower initial tension. Therefore, the present study aimed to compare TE between ACL reconstructions using the double-spike plate (DSP; Smith and Nephew, Andover, Massachusetts) and TensionLoc implant system. Methods A total of 40 patients who underwent anatomical single-bundle ACL reconstruction with a hamstring tendon graft were retrospectively analysed. In the group in which DSP and screw were used, the initial graft tension was set to 40 N at 20° of knee flexion (group D). In the other group in which TensionLoc was used, the initial graft tension was set to 30 N at 20° of knee flexion (group T). Both groups included 20 patients each. Tunnel areas were measured using computed tomography images at one week and three months after surgery, and the TE ratio was calculated according to the following equation: TE ratio (%) = (tunnel area at three months after surgery - tunnel area at one week after surgery)/tunnel area at one week after surgery × 100. Results The femoral TE ratios were significantly higher in group T (80.5% ± 28.8%) than in group D (45.5% ± 34.6%) (p = 0.001). However, the tibial TE ratios did not significantly differ between the two groups. Conclusion Compared with ACL reconstruction using DSP and screw, ACL reconstruction using TensionLoc fixed the graft with lower initial tension but showed greater femoral TE and restricted knee extension in the early postoperative period.
Collapse
Affiliation(s)
- Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
6
|
Leon J, Flanigan DC, Colatruglio M, Ormseth B, Fitzpatrick S, Duerr RA, Kaeding CC, Magnussen RA. Larger Prior Tibial Tunnel Size Is Associated with Increased Failure Risk following Revision Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022. [PMID: 35240716 DOI: 10.1055/s-0042-1743234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We hypothesize that larger prior tunnel size is associated with an increased risk of failure of single-stage revision anterior cruciate ligament reconstruction (ACLR) as defined by the performance of a re-revision (third) ACLR on the index knee. Retrospective review identified 244 patients who underwent single-stage revision ACLR at a single center with available preoperative radiographs. Patient and surgical factors were extracted by chart review. The maximum diameter of the tibial tunnel was measured on lateral radiographs and the maximum diameter of the femoral tunnel was measured on anteroposterior radiographs. Record review and follow-up phone calls were used to identify failure of the revision surgery as defined by re-revision ACLR on the index knee. One hundred and seventy-one patients (70%) were reviewed with a mean of 3.9 years follow-up. Overall, 23 patients (13.4%) underwent re-revision surgery. Mean tibial tunnel size was 12.6 ± 2.8 mm (range: 5.7-26.9 mm) and mean femoral tunnel size was 11.7 ± 2.8 mm (range: 6.0-23.0 mm). Re-revision risk increased with tibial tunnel size. Tibial tunnels 11 mm and under had a re-revision risk of 4.2%, while tunnels > 11 mm had a risk of 17.1% (relative risk: 4.1, p = 0.025). No significant association between femoral tunnel size and re-revision risk was noted. Patients with prior tibial tunnels > 11mm in diameter at revision surgery had significantly increased risk of re-revision ACLR. Further studies are needed to explore the relationship between prior tunnel size and outcomes of revision ACLR.
Collapse
Affiliation(s)
- Jacy Leon
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Matthew Colatruglio
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Benjamin Ormseth
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Sean Fitzpatrick
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Robert A Duerr
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio
| |
Collapse
|
7
|
Lateral posterior tibial slope and length of the tendon within the tibial tunnel are independent factors to predict tibial tunnel widening following anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:3818-3824. [PMID: 33459832 DOI: 10.1007/s00167-020-06419-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to conduct a multivariate analysis to identify independent factors that predict tibial tunnel widening (TW) after anatomical anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) grafts. METHODS In total, 103 patients who underwent ACL reconstructions using BPTB grafts were included. Tunnel aperture area was measured using three-dimensional computed tomography 1 week and 1 year postoperatively, and the tibial TW was calculated. The patients were divided into group S comprising 58 patients who had tibial TW < 30% and group L comprising 45 patients who had tibial TW > 30%, retrospectively. Using univariate analyses, age, gender, body mass index, Tegner activity scale, the time between injury and surgery, tibial tunnel location, tibial tunnel angle, medial posterior tibial slope, lateral posterior tibial slope, and length of the tendon in the tibial tunnel were compared between two groups. Multivariate regression analysis was conducted to reveal the independent risk factors for the tibial TW among preoperative demographic factors and radiographic parameters that correlated with the tibial TW in the univariate analyses. RESULTS Compared with those at 1 week postoperatively, mean tibial tunnel aperture areas were increased by 30.3% ± 26.8% when measured at 1 year postoperatively. The lateral posterior tibial slope was significantly larger (p < 0.001), and the length of the tendon within the tibial tunnel was significantly longer in group L than that in group S (p = 0.03) in the univariate analyses. Multivariate regression analysis showed that the increase in lateral posterior tibial slope (p = 0.001) and the length of the tendon within the tibial tunnel (p = 0.03) were predictors of the tibial TW. CONCLUSIONS This study showed that increased lateral posterior tibial slope and a longer tendinous portion within the tibial tunnel were independent factors that predicted the tibial TW following anatomical ACL reconstruction with a BPTB graft. LEVEL OF EVIDENCE III.
Collapse
|
8
|
Biomechanical Effects of Aspect Ratio of the Knee during Outside-In Anterior Cruciate Ligament Reconstruction Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3454475. [PMID: 34527735 PMCID: PMC8437649 DOI: 10.1155/2021/3454475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022]
Abstract
We analyzed tunnel length, graft bending angle, and stress of the graft according to tunnel entry position and aspect ratio (ASR: ratio of anteroposterior depth to mediolateral width) of the articular surface for the distal femur during single-bundle outside-in anterior cruciate ligament reconstruction (ACLR) surgery. We performed multiflexible body dynamic analyses with four ASR (98, 105, 111, and 117%) knee models. The various ASRs were associated with approximately 1 mm changes in tunnel length. The graft bending angle increased when the entry point was far from the lateral epicondyle and was larger when the ASR was smaller. The graft was at maximum stress, 117% ASR, when the tunnel entry point was near the lateral epicondyle. The maximum stress value at a 5 mm distance from the lateral epicondyle was 3.5 times higher than the 15 mm entry position, and the cases set to 111% and 105% ASR showed 1.9 times higher stress values when at a 5 mm distance compared with a 15 mm distance. In the case set at 98% ASR, the low-stress value showed a without-distance difference from the lateral epicondyle. Our results suggest that there is no relationship between the ASR and femoral tunnel length. A smaller ASR causes a higher graft bending angle, and a larger ASR causes greater stress in the graft.
Collapse
|
9
|
He X, Li Y, Guo J, Xu J, Zu H, Huang L, Tim-Yun Ong M, Shu-Hang Yung P, Qin L. Biomaterials developed for facilitating healing outcome after anterior cruciate ligament reconstruction: Efficacy, surgical protocols, and assessments using preclinical animal models. Biomaterials 2020; 269:120625. [PMID: 33395579 DOI: 10.1016/j.biomaterials.2020.120625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction is the recommended treatment for ACL tear in the American Academy of Orthopaedic Surgeons (AAOS) guideline. However, not a small number of cases failed because of the tunnel bone resorption, unsatisfactory bone-tendon integration, and graft degeneration. The biomaterials developed and designed for improving ACL reconstruction have been investigated for decades. According to the Food and Drug Administration (FDA) and the International Organization for Standardization (ISO) regulations, animal studies should be performed to prove the safety and bioeffect of materials before clinical trials. In this review, we first evaluated available biomaterials that can enhance the healing outcome after ACL reconstruction in animals and then discussed the animal models and assessments for testing applied materials. Furthermore, we identified the relevance and knowledge gaps between animal experimental studies and clinical expectations. Critical analyses and suggestions for future research were also provided to design the animal study connecting basic research and requirements for future clinical translation.
Collapse
Affiliation(s)
- Xuan He
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ye Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jiaxin Guo
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Haiyue Zu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Le Huang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Michael Tim-Yun Ong
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Patrick Shu-Hang Yung
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| |
Collapse
|
10
|
Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Yoneyama T, Omae H, Miyamoto R, Chikuda H. A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong) 2020; 28:2309499019888811. [PMID: 31829103 DOI: 10.1177/2309499019888811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. METHODS Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone double-bundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of ≥27° were classified as group A, while those with a coronal GBA of <27° were classified as group B, those with a coronal GBA of FPLT of ≥23° were classified as group C, while those with a coronal GBA of<23° were classified as group D. RESULTS Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D (p = 0.001). CONCLUSIONS A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.
Collapse
Affiliation(s)
- Shinya Yanagisawa
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Masashi Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Keiichi Hagiwara
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Atsuko Ogoshi
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Tomotaka Yoneyama
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Hiroaki Omae
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Ryosuke Miyamoto
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
11
|
Lee SH, Kim DH, Lee JI, Kim JS, Kim TW, Lee YS. Outcomes of trans-tibial posterior cruciate ligament reconstruction using a fovea landmark technique in relation to tunnel position and serial tunnel configuration. Knee 2020; 27:1942-1952. [PMID: 33221692 DOI: 10.1016/j.knee.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/24/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate (1) the outcome of PCL reconstruction with tibial suspensory fixation using a fovea landmark technique based on the tunnel position and serial change of the tunnel configuration after trans-tibial PCL reconstruction, and (2) whether suspensory fixation has any harmful effect on the outcome. METHODS A total of 48 knees that underwent PCL reconstruction were included. The tunnel position was analyzed using CT. To analyze the tunnel configuration, the tunnel diameter, area, and volume were measured. To evaluate the outcome, pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores were analyzed. To evaluate stability, a side-to-side difference was evaluated using Telos stress radiographs. RESULTS The greatest configurational change occurred at the mid-portion of tibial tunnel. There was a correlation between stability and tibial tunnel mid-portion configurational change (p < 0.01). Important correlations were found between the tunnel position and serial tunnel configuration between high femoral tunnel and widest site of femoral tunnel and tibia aperture (p < 0.01 and 0.04, respectively). The diameter of widest site of tibia tunnel increased when the tibia tunnel center moved toward the posterior margin of the tibia (p = 0.02) and the percentage of femoral tunnel volume enlargement increased when the tibia tunnel center moved toward the medial edge of the PCL fovea (p = 0.02). CONCLUSIONS A high femoral tunnel, medial tibial tunnel, and posterior tibial tunnel were related to the serial configurational change. A suspensory tibial fixation produced significant configurational change around the mid-portion of the tibial tunnel, and it induced a negative effect on stability. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Seung Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopaedic Surgery, Veterans Health Service Medical Center, South Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopedic Surgery, Gwangmyeong 21st Century Hospital, South Korea
| | - Jae Ik Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
| |
Collapse
|
12
|
Choi NH, Lee SJ, Park SC, Victoroff BN. Comparison of Postoperative Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstructions Between Anatomic and Nonanatomic Femoral Tunnels. Arthroscopy 2020; 36:1105-1111. [PMID: 31883708 DOI: 10.1016/j.arthro.2019.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of the location of the femoral tunnel on 3-dimensional (3D) computed tomography (CT) upon the postoperative tunnel widening after anterior cruciate ligament (ACL) reconstructions. METHODS Inclusion criteria were patients who underwent hamstring ACL reconstructions using an adjustable-loop cortical suspension device, underwent 3D CT at the day after surgery, and were followed for a minimum of 2 years after surgery. Exclusion criteria were patients with combined ligament injury and reinjury after reconstruction. Using 3D CT, the center of the femoral tunnel aperture was located on a standardized grid system. The center of the ACL footprint was defined from the literature. The femoral tunnel location was classified as anatomic if it located within 2 standard deviations of the center position. If it was outside the 2 standard deviations, the tunnel was classified as nonanatomic. The patients were divided into either anatomic or nonanatomic groups. Femoral tunnel angles on both sagittal and coronal planes were measured. Both femoral and tibial tunnels measured on anteroposterior and lateral radiographs at immediate postoperative day and at 2 years after surgery. Postoperative knee stability and patient-reported outcomes were evaluated. RESULTS There were 37 patients in anatomical group and 52 patients in nonanatomical group among enrolled 87 patients. There were no differences in demographics between the 2 groups. There were no differences in the femoral tunnel angles and postoperative tunnel widening between the 2 groups. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. Postoperative knee stability and patient-reported outcomes showed no statistically significant differences between the 2 groups. CONCLUSIONS There was no significant difference in postoperative tunnel widening or clinical outcomes between anatomic and nonanatomic femoral tunnel location after hamstring ACL reconstructions. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
Collapse
Affiliation(s)
- Nam-Hong Choi
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea.
| | - Seung-Joo Lee
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Seong-Cheol Park
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A
| |
Collapse
|
13
|
Sundararajan SR, Sambandam B, Singh A, Rajagopalakrishnan R, Rajasekaran S. Does Second-Generation Suspensory Implant Negate Tunnel Widening of First-Generation Implant Following Anterior Cruciate Ligament Reconstruction? Knee Surg Relat Res 2018; 30:341-347. [PMID: 30466254 PMCID: PMC6254873 DOI: 10.5792/ksrr.18.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/20/2018] [Accepted: 08/01/2018] [Indexed: 01/11/2023] Open
Abstract
Purpose Tunnel widening following anterior cruciate ligament (ACL) reconstruction is commonly observed. Graft micromotion is an important contributing factor. Unlike fixed-loop devices that require a turning space, adjustable-loop devices fit the graft snugly in the tunnel. The purpose of this study is to compare tunnel widening between these devices. Our hypothesis is that the adjustable-loop device will create lesser tunnel widening. Materials and Methods Ninety-eight patients underwent ACL reconstruction from January 2013 to December 2014. An adjustable-loop device was used in 54 patients (group 1) and a fixed-loop device was used in 44 patients (group 2). Maximum tunnel widening at 1 year was measured by the L’Insalata’s method. Functional outcome was measured at 2-year follow-up. Results The mean widening was 4.37 mm (standard deviation [SD], 2.01) in group 1 and 4.09 mm (SD, 1.98) in group 2 (p=0.511). The average International Knee Documentation Committee score was 78.40 (SD, 9.99) in group 1 and 77.11 (SD, 12.31) in group 2 (p=0.563). The average Tegner-Lysholm score was 87.25 (SD, 3.97) in group 1 and 87.29 in group 2 (SD, 4.36) (p=0.987). There was no significant difference in tunnel widening and functional outcome between the groups. Conclusions The adjustable-loop device did not decrease the amount of tunnel widening when compared to the fixed-loop device. There was no significant difference in outcome between the two fixation devices. Level of Evidence Level 3, Retrospective Cohort
Collapse
Affiliation(s)
| | - Balaji Sambandam
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospital, Coimbatore, India
| | - Ajay Singh
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospital, Coimbatore, India
| | | | | |
Collapse
|
14
|
Kim YK, Yoo JD, Kim SW, Park SH, Cho JH, Lim HM. Intraoperative Graft Isometry in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Knee Surg Relat Res 2018; 30:115-120. [PMID: 29843198 PMCID: PMC5990230 DOI: 10.5792/ksrr.16.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/03/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose Little is known about the isometry of anatomic single-bundle anterior cruciate ligament (ACL) tunnel positions in vivo although it is closely related to graft tension throughout the range of motion. The purpose of this study was to evaluate intraoperative graft isometry in anatomic single-bundle ACL reconstruction in vivo. Materials and Methods Graft length changes were assessed before bio-screw fixation in the tibial tunnel by pulling the graft with tensions of 20 lbs and 30 lbs in full extension at flexion angles of 30°, 60°, 90°, and 120°. Results At the flexion angle of 30°, 20 lbs and 30 lbs of tension showed −0.4 mm and −0.6 mm length changes, respectively. The greater the flexion angle of the knee, the shorter the graft length in the joint. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension. Conclusions Anatomic single-bundle ACL reconstruction was non-isometric. The graft length was the longest in full extension. The tension of graft became loose in flexion. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension.
Collapse
Affiliation(s)
- You Keun Kim
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Jae Doo Yoo
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sang Woo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sang Hoon Park
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Joon Hee Cho
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Hyung Mook Lim
- Department of Orthopaedic Surgery, Shinchon Yonsei Hospital, Seoul, Korea
| |
Collapse
|
15
|
Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Nakagawa T, Shiozawa H, Ohsawa T. Patient age as a preoperative factor associated with tunnel enlargement following double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28643103 DOI: 10.1007/s00167-017-4611-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE A few studies have detected associations of post-operative tunnel enlargement with sex, age, and the timing of anterior cruciate ligament reconstruction (ACLR). The aim of the present study was to investigate the correlation between post-operative tunnel enlargement following ACLR using hamstring tendon autografts and preoperative factors. The authors hypothesized that tunnel enlargement is associated with age in patients undergoing ACLR. METHODS One hundred and six patients (male, n = 57; female, n = 49; mean age, 26.9 years) who underwent double-bundle ACL reconstruction were included in the present study. The time between injury and surgery was 26.3 ± 71.4 weeks. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months after surgery. The area of the tunnel aperture was measured for the femoral anteromedial tunnel (FAMT), femoral posterolateral tunnel (FPLT), tibial anteromedial tunnel (TAMT), and tibial posterolateral tunnel. The percentage of tunnel area enlargement was defined as the area at 2 weeks after ACLR subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. Spearman's correlation coefficient was calculated for each factor. The patients were divided into two groups based on age. Patients aged <40 and ≥40 years were assigned to Groups A and B, respectively. The differences in the outcomes and characteristics of the two groups were evaluated. RESULTS The percentage of enlargement of the FAMT, FPLT, and TAMT was correlated with patient age (r = 0.31, p = 0.001; r = 0.24, p = 0.012; and r = 0.30, p = 0.002, respectively). In total, 87 and 19 knees were classified into Groups A and B, respectively, based on patient age. The percentage of enlargement of the FAMT was significantly higher in Group B than A (78 vs. 60%, respectively; p = 0.01). The percentage of enlargement of the TAMT was significantly higher in Group B than A (53 vs. 36%, respectively; p = 0.03). CONCLUSION The percentage of enlargement of the FAMT and TAMT was associated with patient age. These findings suggest the need to consider the possibility of tunnel enlargement when double-bundle ACLR is performed for patients aged >40 years. Age was a preoperative factor associated with tunnel enlargement. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Shinya Yanagisawa
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan.
| | - Masashi Kimura
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan
| | - Keiichi Hagiwara
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan
| | - Atsuko Ogoshi
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan
| | - Tomoyuki Nakagawa
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan
| | - Hiroyuki Shiozawa
- Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, Japan
| |
Collapse
|
16
|
The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:491-499. [PMID: 28821912 DOI: 10.1007/s00167-017-4679-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the present study was to investigate the correlation between postoperative tunnel enlargement after ACLR and remnant tissue preservation using the hamstring tendon. METHODS One hundred and ninety-two subjects (male, n = 101; female, n = 91; mean age 27.1) who had undergone double-bundle ACL reconstruction were included in the present study. The patients were divided into two groups: the remnant tissue preservation group (Group R) and the non-remnant tissue preservation group (Group N). Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months after surgery. The area of the tunnel aperture for the anteromedial femoral tunnel (FAMT), posterolateral femoral tunnel (FPLT), anteromedial tibial tunnel (TAMT), and posterolateral tibial tunnel (TPLT) was measured. The area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The differences in the outcomes and characteristics of the two groups were evaluated. RESULTS Seventy-seven knees were classified into Group R, and 115 knees were classified into Group N. The age, gender, and body mass index did not differ to a statistically significant extent. The percentages of FAMT and TAMT enlargement in Group R were significantly smaller in comparison with Group N (P = 0.003 and P = 0.03, respectively). The percentage of FPLT and TPLT enlargement in the two groups did not differ to a statistically significant extent. CONCLUSION The remnant-preserving technique reduces the amount of bone tunnel enlargement. The present findings indicate the advantages of the remnant-preserving ACLR technique, and therefore the remnant-preserving technique should be recommended. LEVEL OF EVIDENCE II.
Collapse
|
17
|
Ni J, Li D, Mao M, Dang X, Wang K, He J, Shi Z. A Method of Accurate Bone Tunnel Placement for Anterior Cruciate Ligament Reconstruction Based on 3-Dimensional Printing Technology: A Cadaveric Study. Arthroscopy 2018; 34:546-556. [PMID: 29122434 DOI: 10.1016/j.arthro.2017.08.288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore a method of bone tunnel placement for anterior cruciate ligament (ACL) reconstruction based on 3-dimensional (3D) printing technology and to assess its accuracy. METHODS Twenty human cadaveric knees were scanned by thin-layer computed tomography (CT). To obtain data on bones used to establish a knee joint model by computer software, customized bone anchors were installed before CT. The reference point was determined at the femoral and tibial footprint areas of the ACL. The site and direction of the bone tunnels of the femur and tibia were designed and calibrated on the knee joint model according to the reference point. The resin template was designed and printed by 3D printing. Placement of the bone tunnels was accomplished by use of templates, and the cadaveric knees were scanned again to compare the concordance of the internal opening of the bone tunnels and reference points. RESULTS The twenty 3D printing templates were designed and printed successfully. CT data analysis between the planned and actual drilled tunnel positions showed mean deviations of 0.57 mm (range, 0-1.5 mm; standard deviation, 0.42 mm) at the femur and 0.58 mm (range, 0-1.5 mm; standard deviation, 0.47 mm) at the tibia. CONCLUSIONS The accuracy of bone tunnel placement for ACL reconstruction in cadaveric adult knees based on 3D printing technology is high. CLINICAL RELEVANCE This method can improve the accuracy of bone tunnel placement for ACL reconstruction in clinical sports medicine.
Collapse
Affiliation(s)
- Jianlong Ni
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Mao Mao
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoqian Dang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Zhibin Shi
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
18
|
Kim YK, Ahn JH, Yoo JD. A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design. Clin Orthop Surg 2017; 9:424-431. [PMID: 29201295 PMCID: PMC5705301 DOI: 10.4055/cios.2017.9.4.424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022] Open
Abstract
Background This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. Methods We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. Results Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. Conclusions When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.
Collapse
Affiliation(s)
- You Keun Kim
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jong Hyun Ahn
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jae Doo Yoo
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| |
Collapse
|
19
|
Giorgio N, Moretti L, Pignataro P, Carrozzo M, Vicenti G, Moretti B. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction. Muscles Ligaments Tendons J 2016; 6:467-472. [PMID: 28217568 DOI: 10.11138/mltj/2016.6.4.467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes. OBJECTIVE The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems. PATIENTS AND METHODS 40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening. RESULTS At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01). CONCLUSIONS This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Nicola Giorgio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Lorenzo Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Paolo Pignataro
- UO University Diagnostic Radiology, Azienda Ospedaliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| |
Collapse
|