Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes

Abstract

Purpose The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) graft using an adjustablelength femoral cortical ixation device with enough patients and a high follow-up rate. Methods This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope ® was used for femoral graft ixation. Clinical evaluations were performed more than 2 years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side diference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer ® . Results Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient sufered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10 months (range 24-68 months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°-5°) was observed in ive patients (8%), whereas one patient (2%) exhibited a loss of lexion (3°-5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side diference in KT value was 0.4 ± 0.7 mm (range − 1-4 mm). Conclusion Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical ixation device provided excellent clinical outcomes both subjectively and objectively more than 2 years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical ixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft. Level of evidence III

Morphometric Analysis of the Tibial Attachment Shape of the Anterior Cruciate Ligament and Its Relationship With the Location of the Anterior Horn of the Lateral Meniscus

“…22,23 Several researchers have developed techniques to modify the shape of the bone tunnel into oval, rectangular, rounded-rectangular, or C shapes, with some favorable early clinical outcomes, to better restore the architecture of the native ACL attachment. 4,14,18,22 The attachment shape on the tibial ACL has been generally considered oval or elliptical. 21,25 Triangular 2,3,20,26 and C-shaped attachments 24 have been reported in recent studies, indicating the variability in the morphology of the attachment site.…”

“…22,23 Several researchers have developed techniques to modify the shape of the bone tunnel into oval, rectangular, rounded-rectangular, or C shapes, with some favorable early clinical outcomes, to better restore the architecture of the native ACL attachment. 4,14,18,22…”

Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft

“…Regardless of whether an auto‐ or allograft was used, BPTB grafts showed superior results to tendon grafts, including the auto‐hamstring tendon and allogenic tibialis anterior tendon, in terms of tunnel enlargement [3, 18]. Tunnel enlargement is the result of the loss of bone that is induced by an imbalance between osteoblastic formation and osteoclastic resorption [25].…”

Mechanical Evaluation of Bone–Patellar Tendon–Bone Graft Fixation to the Tibia in ACL Reconstruction: Bone Plug Tensioning and Fixation System versus Interference Screw

“…Bone–patellar tendon–bone (BTB) grafts are widely used in ACL reconstruction. 3 4 5 6 7 For tibial fixation of the graft, interference screws (IFSs) and pullout suture fixation systems with a screw post, button, and double spike plate (DSP; MEIRA Corporation, Nagoya, Japan) are available. 8 9 10 IFSs are advantageous in shorter interfixation distances, 8 9 while the fixation strength depends on the bone quality.…”