Bone tunnel impaction reduced the tibial tunnel enlargement

Xu, Huan; Zheng, Rongqin; Jin, Ying

doi:10.1515/med-2017-0016

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…Differences in Lysholm scores reported in two studies were not statistically significant both preoperatively (ED: 51.9; SD: 50.1) and postoperatively (ED: 91.7; SD: 93.4). There were no statistically significant differences in Tegner scores reported in one of the studies both preoperatively (ED: 3.5; SD: 3.5) and postoperatively (ED: 6.0; SD: 6.13)(10). Two studies reported no statistically significant differences in IKDC scores preoperatively (ED: 48.6; SD: 49.1) and postoperatively (ED: 92.5; SD: 92.9)(10,16).…”

Section: Resultsmentioning

confidence: 90%

“…There were no statistically significant differences in Tegner scores reported in one of the studies both preoperatively (ED: 3.5; SD: 3.5) and postoperatively (ED: 6.0; SD: 6.13)(10). Two studies reported no statistically significant differences in IKDC scores preoperatively (ED: 48.6; SD: 49.1) and postoperatively (ED: 92.5; SD: 92.9)(10,16). Overall, no statistically significant differences in knee function assays were observed across the clinical studies reviewed.…”

Section: Resultsmentioning

confidence: 90%

“…Serial dilation reduces postoperative tibial tunnel expansion compared to ED. Two studies reported a statistically significant difference in average tibial tunnel width expansion of 1.4 mm from the initial tunnel width in SD and in ED an average tunnel expansion of 1.8 mm from the initial tunnel width (p<0.05)(10,16,18)(Table 3). Regarding ED preparation, there were no reported instances of loose bone/cartilage debris from either tunnel preparation technique that ossified post-operatively or caused post-operative clinical effects.…”

Section: Resultsmentioning

confidence: 99%

“…Extraction drilling (ED) or serial dilation (SD) represent the two most common techniques for tibial tunnel preparation to enhance graft incorporation (9). For a given target tunnel diameter, ED will prepare the tunnel using a drill of the desired diameter as a one-step approach, whereas SD, also known as bone tunnel impaction (10), will initially employ a drill of smaller diameter, and sequentially use dilators of incrementally increasing diameter in a step-wise approach to widen and compact the existing tibial bone to the desired tunnel size. In this fashion, SD aims to compact the cancellous bone to create a stronger anchorage of the graft-fixation-device complex within the tibial tunnel, and potentially avoid the extraction drilling pitfalls of rough tunnel walls and fragmented trabeculae that can theoretically compromise graft strength and functionality (11).…”

Section: Introductionmentioning

confidence: 99%

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No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Crum

Ayeni

et al. 2018

Journal of ISAKOS

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Importance: This review highlights a lack of consensus and need for further study regarding optimal tibial tunnel preparation method in anterior cruciate ligament reconstruction (ACLR). Objective: This review examines existing clinical and biomechanical outcomes of both extraction drilling (ED) and serial dilation (SD) as a technique for tibial tunnel preparation in ACLR. Evidence Review: In accordance with PRISMA guidelines, three electronic databases (MEDLINE, EMBASE, and PubMed) were searched and systematically screened in duplicate from database inception to September 6, 2017 for English-language, human studies, of all levels of evidence that examined ED and/or SD for tibial tunnel preparation in ACLR. Data including patient demographics, tibial tunnel preparation techniques, biomechanical and clinical outcomes and complications were retrieved from eligible studies. Findings: ED was used in 71 patients, who were mean age 29.9 years (range: 17–50), 68% male, and followed for mean 16.5 months (range: 3.8–46). SD was used in 70 patients (70 knees), who were mean age 29.3 years (range: 18–50), 69% male, and followed for mean 14.1 months (range: 3.8–46). There were no statistically significant differences (mean preoperative; mean postoperative) for either tibial preparation technique for Lysholm (50.1; 92.5), Tegner (3.5; 6.1), International Knee Documentation Committee (IKDC) (48.8; 92.7), and Lachman or laxity scores. However, ED demonstrated statistically significant increased postoperative tibial tunnel expansion (1.8 mm versus 1.4 mm) and (at 12 weeks) graft migration at the tibial fixation site (1.3 mm versus 0.8 mm). Across biomechanical studies, there were no statistically significant differences (ED; SD) with forces required to initiate graft slippage (156 N; 174 N), graft stiffness (187 N; 186.5 N), and screw torque (1.6 N/m; 1.8 N/m). ED demonstrated a lower mean load to failure for the graft construct (433 N versus 631 N; p<0.05). Conclusions and Relevance: Though biomechanical data demonstrated lower mean load to failure for the graft using ED, clinical data suggest increased tibial tunnel expansion and post-operative graft migration at the tibial fixation site. Future studies with long-term follow-up data are required to ascertain the optimal technique for graft incorporation and postoperative success. Level of Evidence: IV:Systematic Review of Level I-IV studies.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Crum

Ayeni

et al. 2018

Journal of ISAKOS

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“…If the gap becomes too large, non-union or delayed union may happen even with enough fixation. The gap may be reduced at the tunnel entrance by redirecting the force applies to the graft [25].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Modeling of a Bone Tunnel Enlargement Post ACL Reconstruction

Borjali

Mohseni

Chizari

2020

Preprint

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BackgroundBone tunnel enlargement is considered as a potential problem following ACL reconstruction and can cause a fixation failure and complicate its revision surgery. This study evaluates post tibial tunnel expansion in ACL reconstruction using an interference screw.MethodsA series of in-vitro experimental tests on animal bone and tissues were used to simulate post ACL reconstruction. The study believes an unbalanced lateral force can cause a local enlargement on the contact zone inside the tunnel. Grayscale X-ray images were used to assess the screw alignment inside the tunnel.ResultsThey showed a slight misalignment between the screw and the tunnel axis as the tendon strands moved along the side of the tunnel, and the screw had partial contact with the tendon and bone along the tunnel. According to the results, increased stress in the tunnel wall causes tunnel enlargement. Although the tunnel created away from the tibial central axis produced a higher strength, it results in higher stress on the wall of the tunnel which can increase the risk of tunnel expansion.ConclusionsThe current study believes the use of an unguided interference screw insertion potentially increases risks of the misaligned fixation and cause a tunnel enlargement. This risk may be controlled by restricting the post-operative rehabilitation.

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Synergistic Effect of Reverse Drilling and Bone Dust on Femoral Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction in a Rabbit Model

Yang

et al. 2022

Am J Sports Med

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Background: Anterior cruciate ligament (ACL) injuries and bone tunnel enlargement (BTE) after ACL reconstruction (ACLR) remain frequent issues. Bone dust (BD) produced by tunnel preparation with osteogenic ability and reverse drilling (RD), an easy compaction technique, make it accessible to enhance tendon-bone healing in the clinic. Hypothesis: RD and BD synergistically promote tendon-bone healing by improving peritunnel bone and preventing BTE in femurs. Study Design: Controlled laboratory study. Methods: In total, 96 New Zealand White rabbits underwent ACLR. The semitendinosus tendon was freed before medial parapatellar arthrotomy. After the native ACL was transected, bone tunnels were prepared through the footprint of the native ACL. All animals were randomly assigned to 1 of 4 groups according to different tunnel preparation methods: group 1 (irrigation after extraction drilling [ED]; control group), group 2 (irrigation after RD), group 3 (no irrigation after ED), and group 4 (no irrigation after RD). BD was harvested by irrigating tunnels and was characterized by morphology and size. The specimens underwent microarchitectural, histological, and biomechanical evaluations at 4, 8, and 12 weeks postoperatively. Results: Micro–computed tomography demonstrated more peritunnel bone and less BTE in the femurs of group 4 compared with the other groups. Histologically, BD possessed osteogenic activity in bone tunnels postoperatively. Meanwhile, group 4 regenerated a higher amount of the tendon-bone interface and more peritunnel bone than group 1. Biomechanically, group 4 showed higher failure loads and stiffness than group 1. However, peritunnel bone loss, active osteoclasts, and significant BTE were found in the femurs of group 1 and group 3 at 12 weeks postoperatively, while no strong correlation was found between BTE and inflammatory cytokines. Scanning electron microscopy and particle size analysis suggested that BD produced by ED and RD had no difference in size. Conclusion: Tendon-bone healing was facilitated by the synergistic effect of RD and BD in femurs. Clinical Relevance: This study provides a more accessible and effective surgical strategy to promote tendon-bone healing after ACLR by increasing peritunnel bone and preventing BTE in femurs.

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Bone tunnel impaction reduced the tibial tunnel enlargement

Cited by 4 publications

References 19 publications

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Biomechanical Modeling of a Bone Tunnel Enlargement Post ACL Reconstruction

Synergistic Effect of Reverse Drilling and Bone Dust on Femoral Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction in a Rabbit Model

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